Improving Patient Decisions About Bariatric Surgery
Improving Patient Decisions About Bariatric Surgery
At least 15 million Americans are morbidly obese, or more than 100 pounds overweight. Medical
 treatments including drugs and behavior modification have proven ineffective in producing
 significant and lasting weight loss in this group. While bariatric surgery is extremely
 effective for most patients, it also carries risks for both short and long-term
 complications. There are currently four different types of bariatric surgery available and
 the risks and benefits of these procedures 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 by the beliefs and experiences of the bariatric surgeon that a patient happens
 to see. Variability in the type of surgery recommended to patients likely results from some
 combination of surgeons' subjective opinions and personal experiences with regard to the
 risks and benefits of the treatment options and delegated decision making on the part of
 patients.

 The goals of this research proposal are to develop, implement, and evaluate an informed
 decision support tool for treatment of morbid obesity. This project will be conducted within
 the context of the Michigan Bariatric Surgery Collaborative (MBSC), which is a statewide
 clinical registry and quality improvement program that has the participation of virtually
 every bariatric surgeon and program in the state of Michigan. The MBSC registry now includes
 externally audited clinical data for more than 80,000 consecutive bariatric surgery patients.
 MBSC outcome measures include complications occurring within 30 days as well as weight loss,
 comorbidity resolution, quality of life and satisfaction at 1, 2, and 3 years after bariatric
 surgery.
Our specific aims are:

 1. To 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 35,000 patients already in the MBSC registry) with
 information regarding other salient attributes of the treatment options (derived from
 focus groups and 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 weight loss, patient satisfaction, and improvements in quality of life after
 surgery.

 This research is closely aligned with the goals of PCORI and will have direct impacts on
 patients and caregivers by providing information that is required to improve healthcare
 decision-making for this prevalent, damaging, and costly condition.
Inclusion Criteria:

 -  All patients considering undergoing bariatric surgery in the state of Michigan who are
 18 or older.

 -  All patients, regardless of gender or racial/ethnic background, will be recruited to
 participate in the study in the same way.

 Exclusion Criteria:

 -  Patients under the age of 18