Exploring patient perspectives on shared decision making about bariatric surgery in two healthcare systems

Abstract

Objective: To assess patient perspectives on the level of shared decision making (SDM) experienced related to bariatric surgery.

Background: Severe obesity is common and has serious health implications. Yet, few eligible patients pursue bariatric surgery. Shared decision making could be a useful approach for considering treatment options.

Methods: Patients were surveyed at Kaiser Permanente and UPMC clinics providing bariatric surgical services. Cross-sectional samples represent three time points: (a) Cohort 1 (C1): following referral; (b) Cohort 2 (C2): after initial bariatric practice appointment; (c) Cohort 3 (C3): following pre-operative visit. Patients completed the electronic survey instruments: CollaboRATE, SDM-Q-9, and National Quality Forum (NQF) SDM process measures.

Results: The sample included 167 participants, half from each site. Cohort distribution was 35% C1, 33% C2, and 32% C3. Mean age was 43.8 years (SD 13.5), BMI was 48 kg/m² (SD 8.63), 81% were female and 73% were white. Overall, 62% reported CollaboRATE top scores, with a dose-response (C1: 54%, C2: 60%, C3: 72%). Mean (SD) SDM-Q-9 score (possible range: 0-100) was: 79.6 (22.5); with C1: 66.9 (26.5), C2: 83.4 (18.0), and C3: 88.4 (15.9). The average NQF score (possible range: 0-4) was 3.11 (1.14), with C1: 2.71 (1.27), C2: 3.31 (1.09), and C3: 3.28 (0.97).

Conclusions: Patients seeking bariatric care reported moderate or high levels of SDM. In general, SDM metrics were highest just before surgery.

Keywords: bariatric surgery; obesity; shared decision making.