Surgical appropriateness nudges: Developing behavioral science nudges to integrate appropriateness criteria into the decision making of spine surgeons
Teryl K. Nuckols, Peggy G. Chen, Kanaka D. Shetty, Harsimran S. Brara, Neel Anand, Nabeel Qureshi, David L. Skaggs, Jason N. Doctor, Joshua M. Pevnick, Anne F. Mannion, Surgical Appropriateness Nudge Authorship Group
Abstract
Substantial variation exists in surgeon decision making. In response, multiple specialty societies have established criteria for the appropriate use of spine surgery. Yet few strategies exist to facilitate routine use of appropriateness criteria by surgeons.
Introduction
Substantial variation exists in surgeon decision making regarding which patients may be good candidates for spine surgery and which spine operations may be best for each patient. For example, orthopedic surgeons and neurosurgeons, when provided with case scenarios for degenerative spinal conditions.
Materials and Methods
The National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development proposes best practices for generating, testing, and implementing interventions that are effective at shaping human behavior in real-world settings.
Result
Fifteen surgeons voluntarily participated in the focus groups across the two sites. Surgeons were diverse with regards to age, gender and specialty (e.g., neurosurgery and orthopedic surgery). Six of these surgeons voluntarily participated in the pilot tests.
Discussion
In this study, we designed surgical appropriateness nudges using an iterative primarily qualitative process that leveraged published literature, content experts, spine surgery leaders, and focus groups with spine surgeons at two regional referral centers.
Acknowledgments
Led by the author T. Nuckols, the Surgical Appropriateness Nudge Authorship Group includes: Steven Glassman, MD (Norton Leatherman Spine Center, Norton Healthcare, Louisville, KY); Kenneth Lyles.
Citation: Nuckols TK, Chen PG, Shetty KD, Brara HS, Anand N, Qureshi N, et al. (2024) Surgical appropriateness nudges: Developing behavioral science nudges to integrate appropriateness criteria into the decision making of spine surgeons. PLoS ONE 19(4): e0300475. https://doi.org/10.1371/journal.pone.0300475
Editor: Grigorios L. Kyriakopoulos, National Technical University of Athens: Ethniko Metsobio Polytechneio, GREECE
Received: August 14, 2023; Accepted: February 20, 2024; Published: April 19, 2024
Copyright: © 2024 Nuckols et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: Specific grant numbers [Financial Support and Conflict of Interest Statement: The National Institute on Aging provided funding support for this analysis (1R21 AG059214-01A1). From 2013-2017, the research team received funding support from the Collaborative Spine Research Foundation, a nonprofit fundraising and grants administration organization dedicated to advancing the science and practice of the highest quality spine care. Initials of authors who received each award (TN) URLs to sponsors’ websites: https://www.nia.nih.gov/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: Dr. Skaggs has not received separate funding for this study but previously received funding from NuVasive; royalties from Wolters Kluwer Health, Medtronic, Zimmer Biomet, Globus Medical; consulting fees from ZimmeBiomet, Globus Medical, Top Doctors, Orthobullets; patents pending or received with Medtronic, ZimmerBiomet; and stock or stock options from Zipline Medical, Green Sun Medical, Orthobullets. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0300475#abstract0
