Outcomes Calculators for Informed Decision Making in Back Surgery

项目总结(见说明)： 了解自己的个性化手术获益可能性和伤害风险的患者更有可能做出与他们的目标和价值观一致的治疗选择，但患者在考虑背部手术时往往缺乏与这些决定相关的信息。该项目基于达特茅斯的临床研究人员和一个非营利性消费者研究组织(消费者联盟)之间的独特合作，将开发基于网络的工具，以促进从复杂的 临床试验直接面向医生和患者，应用个性化结果来改进常规临床实践。我们将为NlAMS资助的脊柱患者结果研究试验中研究的三种常见的背痛诊断开发一个基于网络的计算器。预测模型将在内部进行验证，并利用缅因州腰椎研究(MISTH，8.Atlas，PI)和一项大型荷兰腰椎间盘突出症随机试验的数据进行验证。 这项研究的第一阶段将开发和验证结果模型，以预测腰椎手术的益处和风险，该模型基于2427名运动中的背部和腿部疼痛患者的最新8年结果。拟议研究的第二阶段将使用计算器界面的结构化产品开发流程。将就信息架构和设计咨询由医生和方法学家组成的专家小组。将使用患者和专家医生小组的认知访谈和迭代网络开发来为设计和数据呈现的修订提供信息。该项目的第三阶段将在对考虑在参与的体育中心进行手术的提供者和他们的患者的调查中对计算器进行评估，并对消费者联盟订户的便利样本进行评估，以评估其可用性、可理解性以及对考虑背部手术的患者决策的影响。在成功完成验证和评价阶段后，该计算器将作为vveb应用程序免费分发。

PROJECT SUMMARY (See instructions): Patients who understand their individualized likelihood of benefits and risk of harms with surgery are more likely to make treatment choices that are consistent with their goals and values, but patients often lack information pertinent to these decisions when considering back surgery. This project, based on a unique collaboration between clinical researchers at Dartmouth and a non-profit consumer research organization (Consumers Union), will develop web-based tools to facilitate the transfer of scientific results from complex clinical trials directly to physicians and patients, applying individualized results to improve routine clinical practice. We will develop a web-based calculator for each of three common back pain diagnoses studied in the NlAMS-funded Spine Patient Outcomes Research Trial . Prediction models will be validated internally and with data from the Maine Lumbar Spine Study (MISS, 8. Atlas, PI) and a large Dutch lumbar herniated disc randomized trial. The first phase of the study will develop and validate outcomes models for predicting benefits and risks of lumbar spine surgery based on newly available 8-year outcomes for the 2,427 back and leg pain patients in SPORT. The second phase of the proposed research will use a structured product development process for the calculator interface. An expert panel of physicians and methodologists will be consulted concerning information architecture and design. Cognitive interviews and iterative web development using patients and expert physician panels will be used to inform revisions in design and data presentation. The third phase of the project will evaluate the calculator in a survey of providers and their patients considering surgery at participating SPORT centers and a convenience sample of Consumers Union subscribers to evaluate its usability, understandability, and impact on decision-making in patients considering back surgery. Following the successful completion of the validation and evaluation phases, the calculator will be freely disseminated as a vveb application.