Barriers and Facilitators to the Patient Work of Getting to Spine Surgery

Introduction: Older adults worldwide are increasingly diagnosed with degenerative spine disease (DSD). Although frequently interacting with the health system, clinicians are likely not aware of the many health-related activities, or patient work, that older adults engage in to achieve their health goals. An understanding of patient work is needed to improve care systems for people having surgery for DSD. We investigated the patient work system barriers and facilitators for older people with DSD in the journey to spine surgery.

Methods: Secondary analysis of data (28 interviews) from older adults who underwent spine surgery used a human factors framework, the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0, deductive and inductive qualitative content analysis, was used to describe patient work system barriers and facilitators. A code book based on the SEIPS elements (person, task, environment, tools/technology) guided 2-member independent coding, codebook evolution, and then team analysis. Data management and application of the coding scheme was conducted with MAX-QDA software.

Results: Patient work barriers included limited mobility and socialization; negative emotions; multiple providers and appointments; inability to complete household chores and perform self-cares; insurance requirements; waiting for care; home layout; and lack of medication accessibility. Patient work facilitators included self-management knowledge; motivating emotions and mental state; active decision making; treatment options explained and health care providers having knowledge of health care processes; family coordinating care, providing physical/emotional care and monitoring, and taking on household duties; safety features in their home; and using mobility devices.

Conclusion : Barriers to patient work were often a result of the debilitating nature of the symptoms participants experienced causing loss of independence, frustration, and confusion of how to meet their health goal. Facilitators were often actionable and have the potential to positively impact systems of care. A better understanding of patient work can inform future patient-centered quality improvement and research activities.