VIDEODISC FOR BACK SURGERY DECISIONS: A RANDOMIZED TRIAL

研究小组准备了一个教育计划， 媒体（包括电脑和视频光盘），以帮助患者下背部 疾病使更明智的决定接受背部手术。回来 疼痛是这种教育干预的理想问题， 因为它是非常普遍的，卫生保健费用很高（超过24美元 每年10亿美元），背部手术几乎总是一种选择性手术 其主要益处是加速症状缓解。该视频光盘程序 根据患者的年龄， 和诊断，并提供最佳的可用信息， 手术和非手术护理的预期治疗结果。它包括 来自经历过良好和不良结局的实际患者的评论 他们的治疗选择。研究人员现在提出了一个随机的 评估该计划对患者功能状态影响的试验; 对医疗护理的满意度;与以下问题相关的下背部问题的知识 做出知情选择;选择手术治疗的可能性;以及 卫生保健利用。 这项试验将比较腰痛光盘程序， 教育材料作为对腰痛的日常护理的补充。 随机分配到对照组的患者将接受特殊的 设计了一本关于患者治疗选择的小册子。 视频光盘干预组的受试者观看视频节目， 收到一张打印的表格，上面有他们看到的数据。本研究将 在两个研究中心进行：一个封闭式HMO（受试者将 由基层护理实践的外科转介确定）;以及费用- 服务性学术外科实践。遵循教育 将评估干预、患者知识和态度， 记录治疗选择。患者将在三点接受随访。 和12个月来确定他们的健康状况，功能， 满意度和医疗保健利用率。我们预计， 将入组并随机分配600例受试者。因为 不同的实践地点，结果应该是广泛的推广， 将有一些机会来评估 不同的实践中，影碟的种类也各不相同。如果新的影碟 教育技术证明是有效的，它将有助于提高病人 自主权，并赋予患者在医疗保健决策中的权力。可能 也改变了手术率，因为病人在其他情况下已经证明， 比外科医生更厌恶风险， 治疗选择。

The research team has prepared an educational program using interactive media (both computer and videodisc) to help patients with low back disorders make more informed decisions about undergoing back surgery. Back pain is an ideal problem for this type of educational intervention, because it is extremely common, health care costs are high (over $24 billion a year), and back surgery is almost always an elective procedure whose major benefit is accelerated symptom relief. The videodisc program provides an individualized presentation, depending on the patient's age and diagnosis, and provides the best available information regarding expected treatment outcomes of surgical and nonsurgical care. It includes commentary from actual patients who have experienced good and bad outcomes from their treatment choices. The investigators now propose a randomized trial to evaluate the impact of this program on patient functional status; satisfaction with medical care; knowledge of low back problems relevant to making informed choices; likelihood of selecting surgical therapy; and health care utilization. This trial will compare the low back pain videodisc program to written educational materials as adjuncts to usual care for low back pain. Patients randomly allocated to the control group will receive a specially designed brochure on patient treatment choices for low back problems. Subjects in the videodisc intervention group view the video program and receive a printed table of the data they have seen. The study will be conducted in two sites: a closed-panel HMO (where subjects will be identified by surgical referrals from primary care practice); and a fee- for-service academic surgical practice. Following the educational intervention, patient knowledge and attitudes will be assessed, and treatment choices recorded. Patients will then receive follow-up at three and twelve months to determine their health status, function, satisfaction, and health care utilization. We anticipate that a total of 600 subjects will be enrolled and randomly allocated. Because of the different practice sites, the results should be widely generalizable, and there will be some opportunity to assess whether the impact of the videodisc varies in different types of practices. If the new videodisc educational technology proves effective, it will serve to enhance patient autonomy and empower patients in their health care decision-making. It may also modify surgical rates, since patients have proven in other settings to be more risk averse than surgeons, and sometimes make different treatment choices.