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Improving Patient Decisions About Bariatric Surgery

a PSC Research Project

Investigators:   Nancy J. Birkmeyer, Edward Norton, Sarah T. Hawley, Lisa Prosser, Angela Tsai Fagerlin, Mousumi Banerjee, Lawrence C. An

Background: At least 15 million Americans are morbidly obese, or more than 100 pounds overweight.
Bariatric surgery is the only treatment that provides significant and lasting weight loss for most patients in this group. However, there are four different types of bariatric surgery and the risks and benefits of these options vary widely and are strongly affected by patient and clinical characteristics. Decision making under these circumstances should reflect informed patient?s values and preferences regarding these trade-offs. Instead, the choice of bariatric procedure is more often driven more by the beliefs and experiences of the bariatric surgeon that a patient happens to see.
Objectives: 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 will provide patients with an independent assessment of the risks and benefits of the treatment options, not to replace physician?s clinical judgments but rather to augment or guide communication between the patient and physician to promote shared medical decision making.
Methods: We will develop a web-based interactive decision support tool to incorporate tailored information regarding risks and benefits of the treatment options (from regression-based prediction models derived on the 40,000 bariatric surgery patients from a clinical registry) with information regarding other salient attributes of the treatment options (from semi-structured interviews with stakeholders including bariatric surgery patients, bariatric program staff, and surgeons). We will then perform a quasi-experimental study comparing the decision support tool with usual care at 38 hospitals in Michigan to determine its effects on patient decisions (treatment choice, knowledge, treatment preference concordance, and decisional conflict) and on patient outcomes including weight loss, patient satisfaction, and improvements in quality of life after surgery.

Funding Period: 01/01/2014 to 12/31/2016

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