Understanding the complexity of surgical decision-making for individuals with symptomatic lumbar spinal stenosis: A qualitative study
Bibliographic record
Abstract
BACKGROUND: Understanding the factors influencing surgical decisions specific to symptomatic lumbar spinal stenosis (SLSS) can help healthcare providers support patients, set expectations and improve health literacy. Therefore, the purpose of this study is to explore the experiences and perspectives of Canadian patients who choose to undergo surgery for SLSS. METHODS: We used qualitative interpretive phenomenology to understand the surgical decision-making process from individuals with lived experience of SLSS. We conducted semi-structured qualitative interviews that lasted between 30 and 90 min. Inclusion criteria were individuals 55 or older, diagnosed with SLSS, scheduled for or have undergone lumbar spine surgery, and able to speak English. Participants were recruited between October 2019 and September 2021. RESULTS: A total of 32 participants (Men: n = 18; Women: n = 14) were included in this study. Among those participants, 15 were interviewed preoperatively and 17 postoperatively, and all were over 55 years. We identified 5 themes that were woven through the decision-making of respondents, beginning with the experience with healthcare systems and building outwards to the broader social context: (1) Previous experience with non-surgical management, (2) Worrisome symptoms impacting functionality, (3) Perception of surgery as a final course of action, (4) Post-surgical hopes/expectations (i.e., hope that they will be pain-free after surgery), and (5) Having a social support network (i.e., advice and support from family/friends). CONCLUSION: Several experiences may influence an individual's decision to undergo spine surgery, highlighting the importance of integrating a biopsychosocial model in managing SLSS. For chiropractors and manual therapists, these indicators are particularly important, as they often represent a first point of contact for patients with SLSS. Clinicians must maintainperson-centric communication to help patients understand their condition and the clinical treatment pathway for SLSS and develop post-surgical expectations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.015 | 0.014 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".