Testing a decision aid to help patients choose between two types of bariatric surgery
Patients were most likely to select profiles that included resolution of medical conditions (coefficient for full resolution = 0.229 [95% CI, 0.177-0.280], P < .001; coefficient for no resolution = −0.207 [95% CI, −0.284 to −0.189], P < .001), higher total weight loss (coefficient for each add...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
2021, 2021
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Patients were most likely to select profiles that included resolution of medical conditions (coefficient for full resolution = 0.229 [95% CI, 0.177-0.280], P < .001; coefficient for no resolution = −0.207 [95% CI, −0.284 to −0.189], P < .001), higher total weight loss (coefficient for each additional 20% loss = 0.185 [95% CI, 0.166-0.205], P < .001), and lower out-of-pocket costs (coefficient for each additional $1000 = −0.034 [95% CI, −0.042 to −0.025], P < .001). After randomization, similar proportions underwent bariatric surgery, with 35% in the phase 1 decision tool study group and 38% in the control group. The 2 groups had similar proportions of the bariatric surgery procedures. This study provides information on which characteristics are most important from a patient perspective and shows that preferences are heterogeneous. Further, presenting patients with personalized outcomes and preference data does not necessarily reduce decisional regret or affect clinical outcomes. LIMITATIONS: This study had 4 main limitations. First, the main analysis of the RCT was a per-protocol analysis in the subgroup of patients who underwent bariatric surgery, which could introduce selection bias. Second, the tool was developed and discussed at the statewide collaborative's triannual meetings, where providers may have gained knowledge that would influence their discussions with patients and potentially affect the outcomes and satisfaction of our control patients. Third, a post hoc study of the revised decision tool uses historical controls; the results support conducting a future RCT to confirm the findings. We used these data to create and test a revised tool and using a propensity-matched analysis. RESULTS: After creation of the phase 1 decision tool, we randomly assigned 878 patients into the study protocol (control, n = 440; intervention, n = 438). Of those who were randomly assigned, 815 patients (92.8%) completed the conjoint analysis. In these analyses, participants choose between hypothetical profiles composed of attributes of bariatric surgery procedures. Preferences for attributes are expressed as coefficient values. A value >0 indicates that including that attribute level in a surgery profile makes it more likely that the participant will choose that profile. BACKGROUND: Treatment options for morbid obesity include medical management (diet, exercise, behavior modification, weight loss medications, etc) and 1 of 2 main types of bariatric surgery: Roux-en-Y gastric bypass or sleeve gastrectomy. The risks and benefits of these options vary widely and are affected by patient and clinical characteristics. Patients may struggle with deciding which intervention is best for their individual circumstance. Shared decision-making should reflect informed patient values and preferences regarding these trade-offs. OBJECTIVES: The goals of this research were to develop, implement, and evaluate an informed decision support tool for the treatment of morbid obesity. Fourth, the timing of recruitment led to a lower-than-anticipated rate of patients following through with bariatric surgery The decision tool did not affect patient decisional outcomes (ie, overall decisional regret, 80.9 (+/-) 21.5 in the control group vs 83.8 (+/-) 17.5 in the intervention group, P = .20; the scale was 0-100, with lower scores indicating greater regret), satisfaction with surgery at 1 year (79.6% of control patients were very satisfied, and 85.1% of intervention patients were very satisfied), or clinical outcomes (ie, percentage of excess weight lost at 1 year, 61.0% (+/-) 19.8% in the control group vs 61.1% (+/-) 18.3% in the intervention group). We then conducted a propensity-matched comparison of the 154 patients who completed the revised tool and had surgery with 159 RCT control group patients who had surgery. Patients who received the revised tool had less decisional regret than did propensity-matched control patients, with a mean difference of 7.1 points (95% CI, 1.6-12.7 points; P = .0118). CONCLUSIONS: The decision to choose one weight loss method over another is complex. METHODS: We developed a web-based interactive decision support tool that includes (1) a discrete-choice experiment (conjoint analysis, a survey-based approach for measuring preferences2) to identify patient preferences for risks, benefits, and other attributes of the treatment options; (2) tailored information regarding the risks and benefits of the treatment options; and (3) information regarding other salient attributes of the treatment options. We then conducted a randomized controlled trial (RCT) comparing the decision support tool with usual care in patients having surgery at 38 hospitals in Michigan. Primary outcomes included decisional measures (treatment choice, preference concordance, and decisional conflict) and clinical patient outcomes (weight loss, patient satisfaction, and quality of life). Secondary outcomes included satisfaction with and usage data from the decision tool and the patients who used it. |
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| Physical Description: | 1 PDF file (118 pages) illustrations |