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Improving Patient Decisions about Bariatric Surgery

About

Obesity is increasingly considered among the most important public health problems of our times. Bariatric surgery is arguably the only treatment that has proven effective in producing long-term weight loss for patients with morbid obesity. Bariatric surgery also results in resolution of obesity related co-morbid conditions, improvements in quality of life, and increased survival.

There are currently four different bariatric surgical procedures in use: adjustable gastric banding, gastric bypass, sleeve gastrectomy, and duodenal switch. Bariatric surgery is considered a highly preference sensitive medical issue. Existing decision aids in bariatric surgery are limited in that they provide information about the average comparative risks and benefits of the treatment options, but do not provide customized estimates of the risks and benefits of the different procedures for individual patients. As a result of these draw-backs, decision aids are not frequently used in making treatment decisions in bariatric surgery.

Our proposal is highly innovative in that our decision support tool integrates data from a large clinical registry with individual patient data to provide patients with real-time, customized, accurate information regarding the risks and benefits of the treatment options to better inform decision making. This tool will be continuously updated to ensure that the data on risks and benefits that it provides are accurate and current. Our tool also provides information about other attributes of the treatment options that bariatric surgery patients and other relevant stakeholders feel are important for patients to consider in deciding whether and what type of bariatric surgery to have.

The proposed research promotes shared medical decision making for patients who are considering bariatric surgery for the treatment of morbid obesity. If our intervention proves effective, it will result in improved decision quality and outcomes of care for patients. It may also result in improved efficiency of care to the extent that it serves to augment or guide communication between the patient and physician to promote shared medical decision-making.

Aims

The goals of this research proposal are to develop, implement, and evaluate an informed decision support tool for treatment of morbid obesity. This decision support tool provides patients with customized estimates of the risks and benefits of different treatment options and also information about other attributes of the options that affect decision-making.

Our specific aims are:

  1. To develop a web-based interactive decision support tool that incorporates tailored information regarding risks and benefits of the treatment options (from regression-based prediction models derived on the 35,000 patients already in the Michigan Bariatric Surgery Collaborative registry) with information regarding other salient attributes of the treatment options (derived from semi-structured interviews with stakeholders including bariatric surgery patients, bariatric program staff, and surgeons).
  2. To perform a quasi-experimental study comparing the decision support tool with usual care to determine its effects on patient decisions (treatment choice, knowledge, treatment-preference concordance, and decisional conflict) and on patient outcomes including patient satisfaction and improvements in quality of life after surgery.

Participants

We will pilot test the tool among patients recruited from the University of Michigan bariatric program.

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