Study shows value of shared decision-making video aid for bariatric surgery

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Two of our medical editors, David Arterburn of Group Health Cooperative in Seattle, and Karen Sepucha of the Massachusetts General Hospital, were among the authors of a paper in the research journal, Obesity, entitled, “Randomized Trial of a Video-Based Patient Decision Aid for Bariatric Surgery.”

arterburn.jpgKaren Sepucha_83x62.jpgArterburn generally reviews stories on obesity and weight loss for us, and Sepucha specializes in breast cancer issues among her broader interests in decision quality.

The authors concluded:

“The use of bariatric surgery decision aids was followed by improved decision quality and reduced uncertainty about treatment at 3 months. The video-based decision aid appeared to have a greater impact than the educational booklet on patient knowledge, decisional conflict, and outcome expectancies.”

Excerpt of a Group Health news release:

“We think a video like this one can play a key role as people talk with their primary care doctors or specialists, consider pros and cons, and decide whether or not to have bariatric surgery,” said David E. Arterburn, MD, MPH, an associate investigator at Group Health Research Institute. “This is important because U.S. bariatric procedures have increased 20-fold since 1996–from 9,400 to more than 220,000.”

“When an intervention has many pros and cons–as bariatric surgery does–each individual patient’s preferences should play an even larger role than usual,” Dr. Arterburn said. That’s why Dartmouth Atlas Project experts call this kind of care “preference-sensitive.” These experts, who track Medicare spending nationwide, have found that too often this kind of care reflects the practice patterns of the doctors in their area. Instead, he said, preference-sensitive care, including bariatric surgery, should reflect the preferences of individual patients.

For that to happen, it helps for patients to go through a process of “shared decision making” with their doctors, said Dr. Arterburn. In shared decision making, each doctor shares with their patient all relevant information on the possible risks and benefits of detection and treatment options for a health condition. Each patient considers what might make them prefer or tolerate one treatment, side effect, or outcome more or less than others. Then, in conversations with their doctors, patients clarify their preferences, weigh their options, and make the choice that’s right for them, he explained.

Prior studies have shown that informed patients who participate actively in their care decisions tend to choose less invasive options than their physicians would make alone, Dr. Arterburn added. When patients are more informed and active, they also tend to make more conservative choices–and to be more satisfied with their outcomes regardless of whether they choose the intervention or not.

The nonprofit Foundation for Informed Medical Decision Making funded the trial.

The Foundation also developed the content for the video decision aid that was used.

Disclosure: The Foundation supports my project, but had nothing to do with my choice to write about the study.

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