7 Colo. Code Regs. § 1101-3-17-08-6
Introduction. Education about neck pain and associated disability may involve the patient, patient's family, employer, insurer, policymakers, and community. Informed consent and shared decision making are 2 important components of patient education. Informed consent is an individual's autonomous authorization of a medical intervention that has resulted from a conversation between a patient and provider. It is also a formal process that healthcare institutions require before permitting procedures. Shared decision making involves an exchange of ideas between the patient and provider and collaboration in the decision itself.
Recommendations.
Core Requirements.
Recommendation 42. Patient education is required as a primary component of neck pain treatment, beginning with the expected natural history of neck pain, with and without radicular symptoms (table 8).
Recommendation 43. In the setting of benign clinical examination, it is strongly recommended that the provider educates and reassures the patient that there is a high likelihood their condition will improve and that it is essential to self-manage their symptoms.
Recommendation 44. Patient education should include a thorough discussion of how behavioral health evaluation and treatment is an essential component to support recovery from physical injury.
Recommendation 45. Shared decision making is required when 2 or more medically reasonable treatment choices exist, regardless of whether the degree of risk is high or low. Elements of shared decision making for spine interventions must include the following:
* the patient's experience with treatment;
* creation of individualized functional goals of treatment and anticipated barriers to success;
* documentation of expected results of diagnostic testing and possible plan of action in response to test results;
* a discussion of the continuum of treatment from the least invasive to the most invasive, with the intent of identifying a treatment along this continuum that most completely addresses the condition;
* expectation regarding the functional impact of the proposed treatment, including a discussion regarding return to work and expected timeframe for treatment;
* criteria for determining treatment success or failure;
* confirmation of the patient's commitment to perform active therapy to optimize treatment outcomes; and
* consideration of the patient's unique risks and benefits based on comorbid medical conditions
Shared decision making discussions should be tailored to the patient's health literacy.
Recommendation 46. Informed consent is required when a high risk treatment is under consideration. It includes the following elements:
* discussion of the purpose of the proposed treatment;
* benefits and risks of the proposed treatment, alternative treatments, and nontreatment; and
* explicit patient agreement or refusal.
Evidence Tables.
Table 8. Evidence Table: Education and Shared Decision Making | ||
Some evidence | Evidence statement | Design |
Structured educational interventions, whether in the form of written material, oral instruction, or videos, are not expected to lead to significant clinical benefits for whiplash or other neck-associated disorders unless it is combined with exercise or individual advice from a physical therapist. | Systematic review | |
7 CCR 1101-3-17-08-6