Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment

Michael D Rozier; Amir A Ghaferi; Angela M Rose; Norma-Jean Simon; Nancy J Birkmeyer; Lisa A Prosser

doi:10.1016/j.soard.2020.02.005

Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment

Surg Obes Relat Dis. 2020 Jun;16(6):738-744. doi: 10.1016/j.soard.2020.02.005. Epub 2020 Feb 20.

Authors

Michael D Rozier¹, Amir A Ghaferi², Angela M Rose³, Norma-Jean Simon⁴, Nancy J Birkmeyer⁵, Lisa A Prosser⁶

Affiliations

¹ Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri. Electronic address: michael.rozier@slu.edu.
² Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Management and Organizations, University of Michigan Ross School of Business, Ann Arbor, Michigan.
³ Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
⁴ Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois.
⁵ Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
⁶ Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan.

PMID: 32205098
DOI: 10.1016/j.soard.2020.02.005

Abstract

Background: Increased attention to shared decision-making is particularly important in bariatric surgery. It is unclear whether the large shift toward sleeve gastrectomy is evidence of good alignment between patient and surgeon preferences.

Objective: To identify surgeon preferences for risks, benefits, and other attributes of treatment options available for bariatric surgery and to compare results with patient preferences.

Setting: Online survey.

Methods: A discrete choice experiment of weight loss procedures. Each procedure was described by the following set of attributes: (1) treatment method, (2) recovery and reversibility, (3) years treatment has been available, (4) expected weight loss, (5) effect on other medical conditions, (6) risk of complication, (7) side effects, (8) changes to diet, (9) out-of-pocket costs. Participants chose between surgical profiles by comparing attributes. A convenience sample of providers for the online survey was recruited via LISTSERVs of professional associations.

Results: Respondents (n = 121) were most likely to select profiles of hypothetical procedures based on the resolution of existing medical conditions and higher expected weight loss. These results align with patient preferences. However, surgeons selected profiles based on lower risk of complications than did patients and surgeons were less sensitive to out-of-pocket costs than patients.

Conclusions: Results show strong alignment between the preferences of patients and the preferences of surgeons when they are asked to stand in the place of their patients. Some differences, especially those related to sensitivity to risk of complications and out-of-pocket costs indicate that shared decision-making would benefit from providers explaining their concerns about surgical risk and from appreciating the concern many patients have about financial costs.

Keywords: Bariatric surgery; Discrete choice experiment; Shared decision-making.

MeSH terms

Bariatric Surgery*
Humans
Patient Preference
Surgeons*
Surveys and Questionnaires
Weight Loss