Exploring patient perspectives on shared decision making about bariatric surgery in two healthcare systems

To assess patient perspectives on the level of shared decision making (SDM) experienced related to bariatric surgery.

Severe obesity is common and has serious health implications. Yet, few eligible patients pursue bariatric surgery. Shared decision making could be a useful approach for considering treatment options.

Patients were surveyed at Kaiser Permanente and UPMC clinics providing bariatric surgical services. Cross-sectional samples represent three time points: (a) Cohort 1 (C1): following referral; (b) Cohort 2 (C2): after initial bariatric practice appointment; (c) Cohort 3 (C3): following pre-operative visit. Patients completed the electronic survey instruments: CollaboRATE, SDM-Q-9, and National Quality Forum (NQF) SDM process measures.

The sample included 167 participants, half from each site. Cohort distribution was 35% C1, 33% C2, and 32% C3. Mean age was 43.8 years (SD 13.5), BMI was 48 kg/m² (SD 8.63), 81% were female and 73% were white. Overall, 62% reported CollaboRATE top scores, with a dose-response (C1: 54%, C2: 60%, C3: 72%). Mean (SD) SDM-Q-9 score (possible range: 0-100) was: 79.6 (22.5); with C1: 66.9 (26.5), C2: 83.4 (18.0), and C3: 88.4 (15.9). The average NQF score (possible range: 0-4) was 3.11 (1.14), with C1: 2.71 (1.27), C2: 3.31 (1.09), and C3: 3.28 (0.97).

Patients seeking bariatric care reported moderate or high levels of SDM. In general, SDM metrics were highest just before surgery.