Experience and Evidence-Based Knowledge
In the traditional, “the doctor knows everything” treatment approach, the doctor decides on surgery only by measuring the curve magnitudes, then informs the patient on the surgical planbased on his findings. Because the surgeon is extremely busy in his everyday work, the patient is not informed about the pre- and post-operative periods and therefore the patient’s expectations might not be met after the surgery.
In the standard treatment-oriented approach, major factors affecting the surgical desicion are traditional evaluation of the patient and the curve magnitude.This decision-making process is not wrong, but lacks important information. Curve measurements have an error of measurement. There might not be consensus related to the level of the surgery among surgeons. So-called “grey-zone curves” are close to the surgical limit but also may be addressed non-surgically.
In modern approach, scoliosis surgical decision-making is not based alone on the surgeon’s experience. It’s based on the surgeon’s experience and evidence-based knowledge regarding the treatment as well as the patients’ condition, expectations, and the effect of deformity on the patient’s quality of life.
Recent studies demonstrate that the surgeon’s experience and number of cases the surgeon addresses directly correlates with good outcomes. Evidence-based decisions is one of the most important elements in contemplating surgery. Therefore, it is extremely important that the surgeon is up-to-date with current literature, performs research and follows the novelties in spinal surgery.
In the modern patient-centered approach, surgeons consider the magnitude measured on X-rays as well as the amount of deformity, balance problems and the curve’s effect on the patient’s quality of life.Patient quality of life is determined with standardized questionnaires: With the help of multiple choice and open-ended questions, patient’s pain scores, functional activity level, self image perceptions, and mental health status are evaluated.
Patient Education
The surgeon’s and patient’s expectations must match. If the surgeon is in favor of surgical treatment, he or she must discuss with the patient:
- The patient’s opinion
- The surgery timing
- Alternative methods
- Expectations during the pre- and post- operative period
- Expected effects of the surgery to the patient’s daily life
- Adaptation period
This process is patient-education. This coordinator nurse should repeat this training, and the patient should receive relevant documents, brochures, and booklets to be fully informed of their situation and post-surgery expectations.
In summary, the decision to opt for surgery isn’t soley made by the surgeon—it’s an agreed-upon desision by the patient and the surgeon after comprehensive evaluation of the expectations. The surgeon must spare enough time for the patient, and the patient needs to be informed by the surgeon and team members using visual and written documents.