• Palvasha Deme, Anjali Perera, Sai Chilakapati, Sonja Stutzman, Ravinderjit Singh, Cody M Eldridge, James Caruso, Shaleen Vira, Salah G Aoun, Una E Makris, Carlos A Bagley, and Owoicho Adogwa.
• Department of Neurosurgery, University of Texas Southwestern Medical School, Dallas, TX.
• Spine. 2022 May 15; 47 (10): 730-736.

Study DesignRetrospective.ObjectiveTo understand patients' and spine surgeons' perspectives about decision-making around surgery for adult spinal deformity.Summary Of Background DataSurgery for correction of adult spinal deformity is often beneficial; however, in over 20% of older adults (≥ 65 yrs of age), outcomes from surgery are less desirable.Materials And MethodsWe conducted semistructured, in-depth interviews with six patients and five spine surgeons. Two investigators independently coded the transcripts using constant comparative method, as well as an integrative, team-based approach to identify themes.ResultsPatients themes: 1) patients felt surgery was their only choice because they were running out of time to undergo invasive procedures; 2) patients mentally committed to surgery prior to the initial encounter with their surgeon and contextualized the desired benefits while minimizing the potential risks; 3) patients felt that the current decision support tools were ineffective in preparing them for surgery; and 4) patients felt that pain management was the most difficult part of recovery from surgery. Surgeons themes: 1) surgeons varied substantially in their interpretations of shared decision-making; 2) surgeons did not consider patients' chronological age as a major contraindication to undergoing surgery; 3) there is a goal mismatch between patients and surgeons in the desired outcomes from surgery, where patients prioritize complete pain relief whereas surgeons prioritize concrete functional improvement; and 4) surgeons felt that patient expectations from surgery were often established prior to their initial surgery visit, and frequently required recalibration.ConclusionOlder adult patients viewed the decision to have surgery as time-sensitive, whereas spine surgeons expressed the need for recalibrating patient expectations and balancing the risks and benefits when considering surgery. These findings highlight the need for improved understanding of both sides of shared decision-making which should involve the needs and priorities of older adults to help convey patient-specific risks and choice awareness.Level Of Evidence3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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