Development and Acceptability of a Patient Decision Aid for People with Degenerative Cervical Myelopathy: An International Mixed-Methods Study

Authors

• Andrew R. Gamble, University of Sydney
• David B. Anderson, University of Sydney
• Marnee J. McKay, University of Sydney
• Benjamin M. Davies, University of Cambridge
• Sophie Macpherson, University of Sydney
• James Van Gelder, Concord Repatriation General Hospital
• Tammy Hoffmann, Bond University
• Kirsten McCaffery, University of Sydney
• Samuel X. Stevens, University of Sydney
• Carlo Ammendolia, University of Toronto
• Rohil V. Chauhan, Auckland University of Technology
• Carl M. Zipser, University of Zurich
• Timothy F. Boerger, Marquette UniversityFollow
• Lindsay A. Tetreault, Mass General Brigham
• Michael G. Fehlings, University of Toronto
• Elanor Dustan, Nottingham University Hospitals
• Carolyn Nugent, University of Cambridge
• Helen Holmgren, University of Cambridge
• Andreas K. Demetriades, Royal Infirmary - Edinburgh
• Justin M. Lantz, University of Southern California
• Rana Dhillon, University of Melbourne
• Chris G. Maher, University of Sydney
• Joshua R. Zadro, University of Sydney

Document Type

Article

Publication Date

4-2026

Publisher

BMJ Publisheing Group

Source Publication

BMJ Open

Source ISSN

2044-6055

Abstract

Objectives To develop and user-test a patient decision aid for people diagnosed with degenerative cervical myelopathy and who are considering surgery.

Design Mixed-methods study describing the development of a patient decision aid.

Setting A draft decision aid was developed by a multidisciplinary steering group (including study authors with degenerative cervical myelopathy, health professionals and researchers) informed by the best available evidence, authorship consensus and existing patient decision aids.

Participants Patient-participants and health professional-participants who manage people with degenerative cervical myelopathy were recruited through social media and the steering group’s research and practice network. Quantitative questionnaires were used to gather baseline data, descriptive feedback, refine the decision aid and assess its acceptability. Qualitative semi-structured interviews were conducted online to gather feedback on the decision aid and were analysed using reflexive thematic analysis.

Results We conducted 32 interviews: 19 patient-participants and 13 health professional-participants who manage people with degenerative cervical myelopathy (neurosurgeons, neurologists, physiotherapists, orthopaedic surgeons, general practitioners, rehabilitation and pain specialists and consultant occupational physicians and chiropractors). Participants were from 10 countries (Australia, Canada, Cyprus, Germany, Ireland, New Zealand, Sweden, Switzerland, United Kingdom and USA). Most participants rated the decision aid’s acceptability as good-to-excellent and agreed with most aspects of the decision aid (eg, defining degenerative cervical myelopathy, management recommendations, potential benefits and harms, questions to consider asking a health professional).

Conclusion Our patient decision aid was rated as an acceptable tool by both health professional-participants who treat degenerative cervical myelopathy and patient-participants with lived experience of degenerative cervical myelopathy. This decision aid can be used by clinicians and people with degenerative cervical myelopathy to help with shared decision making following a diagnosis of degenerative cervical myelopathy. A study testing the potential benefits of this decision aid in a clinical setting is recommended.

Comments

Published version. 

BMJ Open, Vol. 16, No. 4 (2026): e106337. DOI. © 2026 Author(s) (or their employer(s)) 2026. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the license is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Gamble, Andrew R.; Anderson, David B.; McKay, Marnee J.; Davies, Benjamin M.; Macpherson, Sophie; Van Gelder, James; Hoffmann, Tammy; McCaffery, Kirsten; Stevens, Samuel X.; Ammendolia, Carlo; Chauhan, Rohil V.; Zipser, Carl M.; Boerger, Timothy F.; Tetreault, Lindsay A.; Fehlings, Michael G.; Dustan, Elanor; Nugent, Carolyn; Holmgren, Helen; Demetriades, Andreas K.; Lantz, Justin M.; Dhillon, Rana; Maher, Chris G.; and Zadro, Joshua R., "Development and Acceptability of a Patient Decision Aid for People with Degenerative Cervical Myelopathy: An International Mixed-Methods Study" (2026). Biomedical Engineering Faculty Research and Publications. 740.
https://epublications.marquette.edu/bioengin_fac/740