PATIENT DISCORDANCE BETWEEN SURGERY CHOICE AND TREATMENT-RELATED VALUES: A PRELIMINARY STUDY OF BARIATRIC PATIENTS

  

Purpose: To determine whether a discordance exists between the bariatric procedures patients choose (gastric bypass, gastric band, or sleeve gastrectomy) and their treatment-related values (outcomes and complications).   

Methods: An anonymous bilingual (English/Spanish) questionnaire was administered to new patients at the Bellevue Hospital Bariatric Surgery Program. The Bariatric Clinic requires patients to attend an information seminar and consult with a multidisciplinary team before making a surgical choice. The questionnaire was administered after the seminar, but before the consultation, and included knowledge questions on the outcome and complication profiles of the 3 surgical treatments and questions about the patients' treatment-related values.   

Results: 64 patients completed the questionnaire. The mean Body Mass Index (BMI) was 44.5 kg/m² and 25.0% were diabetic. Patients answered correctly an average 62.9% of the knowledge questions. 42.2% of patients chose gastric bypass, 40.6% sleeve gastrectomy, and 17.2% gastric banding (Table 1).  29% of patients changed their surgical choice following consultation with the multidisciplinary team. In patients who chose gastric banding, 36.4% selected weight loss as their most important outcome (gastric banding affords the least weight loss of the 3 procedures). In diabetic patients, 36.4% cared more about weight loss than curing their diabetes. When patients' target BMI was calculated using preoperative BMI and evidence-based estimates of excess body weight loss for each of the 3 bariatric procedures, 66.7% of those who chose gastric banding had a target BMI above 35, meaning they would remain severely obese postoperatively.   

Conclusions: This study found that many patients choose a bariatric procedure with an outcome and complication profile that is inconsistent with their values, and that a significant subgroup of patients (29.0%) change their surgical choice after consultation with the medical team. These results strongly indicate that patients and physicians would benefit from a decision-making model, which integrates patient values, to assist in the complicated surgery selection process.  Table 1. Outcome and complication profile for all patients

			Most important outcome				Most worrisome complication
Surgery	#Patients (%)	#Diabetic patients (%)	Weight loss	Curing diabetes	Least weight regain	Fewest appts.	Leak	Slip/ erosion
Gastric bypass	27 (42.2)	9 (56.2)	59.3%	14.8%	25.9%	0	66.7%	33.3%
Sleeve gastrectomy	26 (40.6)	6 (37.5)	61.5%	15.4%	23.1%	0	53.8%	46.2%
Gastric band	11 (17.2)	1 (6.3)	36.4%	9.1%	54.6%	0	45.5%	54.5%