Chronic nonspecific back pain

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Chronic nonspecific back pain

• Masters in Health Journalism
• Capstone Presentation
• Greg Turosak
• April 28, 2005

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Agenda for today

• Goals of a capstone in this program
• How this project fits into those goals
• What are Health Decision Guides?
• Rationale, evidence supporting HDGs
• How was this topic decided upon?
• Whats so interesting about chronic back pain?
• How was this topic researched and developed?
• What medical/expert advice influenced this
  project?
• Where can you find this project now, in the
  future?
• A look at selected parts of this project
• Questions

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Goals, requirements of a capstone

• An important health issue
• Contributes to public understanding
• Publishable in any medium
• Proceeds in consultation with academic adviser
• Involvement of a faculty member outside the
  advisers academic unit
• Involvement of outside professionals
• Work invested comparable to that of a 4-credit
  graduate level course

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How this project meets the capstone goals

• Back pain is a common, often serious problem
• Public may have little understanding about how
  much they can do vs. how much intervention is
  needed
• Project was published on the Web
• Project approved by academic adviser and reviewed
  by faculty member outside the unit
• Project reviewed by 5 outside professionals (4
  Mayo Clinic doctors, 1 senior editor at
  MayoClinic.com)
• Work invested exceeded that comparable to a
  4-credit graduate level course

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What are Health Decision Guides and their
characteristics?

• They address health conditions that are common
  and potentially costly to treat
• They address issues for which treatment options
  are inconclusive
• Patients must weigh risks and benefits in
  choosing which option is best for them
• Patients gain valuable knowledge to (a) better
  communicate with their doctors and (b) make
  informed decisions

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MayoClinic.coms other HDGs
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Examples of existing HDGs (1)
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Examples of existing HDGs (2)
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Examples of existing HDGs (3)
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What Have We Learned? Increased confidence in
ability to make informed treatment decision
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What Have We Learned?
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The concept ofShared Decision Making

• Rates of elective surgery and discretionary
  intervention vary widely across U.S.
• Medical paternalism has strong influence on
  this trend
• Lack of informed choices by patients contributes
  to trend
• A new model is emerging
• Patients are sharing in decisions with their
  doctors
• In shared decision making, the treatment choices
  are not clear-cut
• Shared decision making implies weighing of
  complex trade-offs on a case-by-case basis

Source Dartmouth University
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Choosing HDG Topics

• Is there no gold standard treatment, test?
• Is the evidence inconclusive?
• Are there reasonable options?
• Must a patient ultimately weigh what risks they
  can tolerate and what benefits they prefer?
• Is it common and potentially costly?
• Are specialty M.D. resources available?
• Is the topic meaningful for our users/customers?

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Why is back pain so interesting?

• Extremely common
• Major impact on quality of life
• Major impact on the workplace
• Major costs to society
• The course of treatment is not clear

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How was this topic developed/timeline?

• Early 2004 Discussions with Gary Schwitzer and
  MC.com about suitability of an HDG for the
  capstone and which topic both sides OK
• Summer 2004 Outline developed research begins
  Dr. Vercellotti lined up as an adviser
• Fall 2004 Writing begins recruitment of
  personal story candidates initial review by Dr.
  Vercellotti and reviewers at Mayo Clinic
• Spring 2005 Completion of project final
  reviews by Gary Schwitzer and at Mayo Clinic
  online publication presentation at U of M

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Chronic nonspecific back pain Health Decision
Guide outline

• I. Welcome
• II. About chronic nonspecific back pain
• A. Anatomy of the spine
• B. Symptoms
• C. Common causes
• D. When the cause is unknown
• III. Treatment options
• A. Noninvasive treatments
• 1. Pros and cons
• B. Invasive treatments
• 1. Spinal fusion
• 2. Other invasive treatments
• 3. Pros and cons
• C. Complementary and alternative approaches
• D. Emerging therapies
• E. Watchful waiting
• IV. Meet the Mayo Clinic doctor
• V. Personal stories
• A. Meet Robert Moore

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Key advisers/professionals/1

• Academic adviser Gary Schwitzer, assistant
  professor, SJMC gt
• lt Faculty adviser from outside the unit Dr.
  Gregory Vercellotti, senior associate dean,
  Medical School Admin/Educ
• Jay Maxwell, senior editor, MayoClinic.com gt

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Key advisers/professionals/2

• Dr. Randy Shelerud, Department of Physical
  Medicine and Rehabilitation, Mayo Clinic Spine
  Center gt
• lt Dr. Ed Laskowski, PMR, Mayo Clinic Sports
  Medicine Center
• Dr. Brad Currier, orthopedic surgeon, Mayo Clinic
  gt
• lt Dr. Ken Berge, senior medical editor,
  MayoClinic.com

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Where can you find this HDG now and in the
future?

• A look now (April 2005-April 2006)
  https//secure.mayoclinic.com/login/login.cfm?wwwi
  dMyMayoHealth.comimsecure1
• (password-protected site)
• A look in the future (April 2006)
• http//www.mayoclinic.com/health/back-pain-treatm
  ent/BA99999
• (public site)

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Project screenshot (1)
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Project screenshot (2)
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Project screenshot (3)
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Project screenshot (4)
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Project screenshot (5)
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Personal profile candidates

• Ann Nolan. 30-something. Plainview, MN. Opted for
  spinal fusion. gt
• Robert Moore. 60-something. Vienna, VA. Opted for
  multifaceted nonsurgical approach. gt
• Candidates from among a small group suggested by
  Dr. Shelerud. Request was made for as much
  racial, age and sex diversity as possible.

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The primary medical reviewer

• Director, Spine Center, Mayo Clinic Rochester
• Consultant, Department of Physical Medicine and
  Rehabilitation, Mayo Clinic Rochester
• Instructor in Physical Medicine Rehab, Mayo
  Clinic College of Medicine, Rochester, MN

Dr. Randy Shelerud
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Challenges of project

• Reviewing a large amount of material
• Striking the right tone, balance
• Putting things in proper context
• Identifying suitable personal story candidates
• Identifying and creating artwork
• Writing so much material in a scannable,
  approachable manner

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And finally

• Your questions and comments