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Prospective Assessment of a Decision Aid to Help Individuals Considering Upper Extremity Reconstruction in Cervical Spinal Cord Injury.
William R. Moritz, MD1; Sarah N. Chiang, B.S.2; Carie R. Kennedy, BSN3; Doug Ota, MD4; Catherine Curtin, MD5; Katherine C Stenson, MD6; Katharine Tam, MD7; Mary Politi, PhD1; Fox K Ida, MD8
1Washington University, St. Louis, MO; 2Washington University School of Medicine in St. Louis, St. Louis, MO; 3Washington University in St. Louis, St Louis, MO; 4Palo Alto Veterans Healthcare System, Palo Alto, CA; 5Stanford Hospital and Clinics, Palo Alto, CA; 6VA St. Louis Healthcare System, St Louis, MO; 7St Louis VA Medical Center, St Louis, MO; 8Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO

Background: Surgical treatment decision-making is challenging and should incorporate consideration of biologic, practical, and other factors. For example, both nerve and tendon transfer can restore upper extremity (UE) function and independence in mid-cervical spinal cord injury (SCI). However, few eligible individuals (~14%) undergo either surgery. One barrier is lack of information regarding these complex and, sometimes, time-sensitive treatment options.

Patient decision aids (DAs) can be used to present complex health information in clear, accessible language, clarify individuals’ goals of care, and improve self-efficacy and autonomy in making treatment decisions. The purpose of this study is to evaluate a newly created DA for people with SCI considering options for UE reconstructive surgery.
Methods: A prospective within-subject study design was used to test the DA. The DA was developed based on clinical evidence, our previous work, and the Ottawa Decision Support Framework. Adults with SCI were recruited and enrolled; those who had previously undergone nerve or tendon transfer were excluded. Participants completed a knowledge and decisional conflict survey before and after reviewing the web-based DA. Knowledge about surgical treatment options, risks and benefits was compared using a paired-sample t-test. A validated measure of decisional conflict (uncertainty and unmet needs about a choice) was compared using a Chi-squared test.
Results: 40 participants completed the study activities (83% male, 17% female; mean age, 54.6 years). Participants had a 24% increase in knowledge after using the DA (SD=21%, p<0.0001) (Figure 1A). The number of participants experiencing decisional conflict decreased after viewing the DA (31 vs. 17, p=0.003) (Figure 1B).
Conclusions: This DA improves knowledge of treatment options and reduces decisional conflict about UE reconstruction after SCI. It is particularly useful when considering relatively novel application of nerve transfer surgical techniques. Future work should include testing in the real-world clinical setting.


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