Effect of a discordant opinion offered by a second opinion physician on the patient's decision for management of spinal disc disease.

BACKGROUND: Factors that influence a patient's decision for spinal surgery and selection of the spine surgeon have not been studied in the context of a Second Opinion (SO). Providing insight into these factors will guide surgeons in their discussion of treatment options with patients. OBJECTIVE: This study aims to assess the impact of a discordant SO on the final decision of patients as compared to their initial preference regarding spinal disc disease treatment for chronic neck and low back pain. PATIENT INVOLVEMENT: Patients in this study engage in clinical vignettes designed to induce decisional conflict. METHODS: A cross-sectional study using clinical vignette-based questionnaires was presented to patients at the Family Medicine, Orthopedic, and Neurosurgery clinics at a university-based tertiary academic medical center. RESULTS: A total of 246 patients participated in the study (response rate, 66.8%). Irrespective of the initial offered treatment, most patients wanted to consult a SO (64.2%). Most patients preferred conservative treatment to surgery after getting the initial recommendation (78.5%) and after getting a discordant SO (56.5%). There was an association between the agreement of the patient with the initial recommendation and the effect of the SO on the final decision of patients (p < 0.001). Patients who disagreed with the initially offered treatment were more likely to abide by their initial decision after the SO (80.8%) as compared to those who were in agreement (17.7%), while those who agreed with the initially offered treatment were more likely to change their decision (39.5%) or to take a third opinion (42.9%). DISCUSSION: A discordant SO may validate patients' wishes when they disagree with the initially offered treatment and may lead to confusion when they agree with the initial physicians' recommendations. PRACTICAL VALUE: As patients tend to abide by their initial preference, physicians should explicitly consider patients' wishes when discussing options for management of spinal disc disease.