DECISIONAL CONFLICT IN MORBIDLY OBESE PATIENTS CONSIDERING BARIATRIC SURGERY
Daniel P. Schauer, MD, MSc1, David Arterburn, MD, MPH2, Calvin Selwyn, MD1, Ruth Wise, MSN1, and Mark Eckman, MD, MS1. (1) University of Cincinnati, Cincinnati, OH, (2) Group Health Cooperative, Seattle, WA
Purpose: The goal of this study was to establish whether patients attending a bariatric surgery interest group were uncertain about their decision and what factors were associated with decisional conflict. Methods: Based on published models of shared decision-making, we developed a 55 item survey to assess decisional conflict and potential predictors of decisional conflict in patients recruited from the bariatric surgery ‘interest group meeting' associated with a large, multidisciplinary, university-based bariatric practice. The decisional conflict scale is a 16 item questionnaire with 5 response categories for each statement, scored on a scale of 0 to 100 that measures personal perceptions of uncertainty and modifiable factors contributing to effective decision making. Scores less than 25 on this scale are associated with implementing a decision. The potential predictors of decisional conflict for bariatric surgery included demographics, body mass index (BMI), the presence of obesity associated conditions, and factors related to the bariatric surgery program visited. Multivariable logistic regression models were developed to assess the relationship between our predictors of interest and having a decisional conflict score less than 25. Results: We recruited 56 patients who completed the survey at the bariatric surgery interest groups over a three month period. The mean age was 43 years, 80% were female and the mean BMI was 47 kg/m2. 80% of the patients had at least one comorbid condition. The median decisional conflict score was 21 with 24 (44%) patients having a score greater than 25. Patients with decisional conflict tended to be younger and male. A decisional conflict score less than 25 was significantly associated with having at least one obesity associated comorbid condition (OR 0.09, 95% C.I. 0.02 to 0.55), visiting two or more surgical programs (OR 0.12, 95% C.I. 0.02 to 0.97) and having already made a decision (OR 0.19, 95% C.I. 0.04 to 0.76) in the multivariable model. Conclusions: In patients considering bariatric surgery for the treatment of morbid obesity, nearly half have significant decisional conflict. Decisional conflict decreases as the number of obesity associated comorbid conditions increases and the number of surgical programs visited increases. Further research is needed on interventions to reduce decisional conflict in morbidly obese patients seeking information on bariatric surgery.