Patient experiences of decision-making in the treatment of spinal metastases: a qualitative study

Abstract

Background: In the treatment of spinal metastases the risks of surgery must be balanced against potential benefits, particularly in light of limited life-expectancy. Patient experiences and preferences regarding decision-making in this context are not well explored.

Purpose: We performed a qualitative study involving patients receiving treatment for spinal metastatic disease. We sought to understand factors that influenced decision-making around care for spinal metastases.

Study setting: Three tertiary academic medical centers.

Patient sample: We recruited patients presenting for treatment of spinal metastatic disease at one of three tertiary centers in Boston, MA.

Outcome measures: We conducted semistructured interviews using a guide that probed participants' experiences with making treatment decisions.

Methods: We performed a thematic analysis that produced a list of themes, subthemes, and statement explaining how the themes related to the study's guiding questions. Patients were recruited until thematic saturation was reached.

Results: We interviewed 23 participants before reaching thematic saturation. The enormity of treatment decisions, and of the diagnosis of spinal metastases itself, shaped participant preferences for who should take responsibility for the decision and whether to accept treatments bearing greater risk of complications. Pre-existing participant beliefs about decision-making and about surgery interacted with the clinical context in a way that tended to promote accepting physician recommendations and delaying or avoiding surgery.

Conclusions: The diagnosis of spinal metastatic disease played an outsized role in shaping participant preferences for agency in treatment decision-making. Further research should address strategies to support patient understanding of treatment options in clinical contexts-such as spinal metastases-characterized by ominous underlying disease and high-risk, often urgent interventions.

Keywords: Decision making; Provider communication; Qualitative research; Radiation oncology; Spinal metastases; Surgical management.