Study Testing Patient Decision Tools Related to the Risks and Benefits of Weight Loss Surgery
Condition: Obesity, Morbid; Obesity; Decision Aids; Bariatric Surgery
MeSH terms: Obesity; Obesity, Morbid
Study type: Interventional

Summary: 
      Morbid obesity currently affects more than 11 million US adults and is strongly associated
      with type 2 diabetes, cancer, cardiovascular disease, and arthritis. Bariatric (weight loss)
      surgical procedures have been shown to significantly reduce body weight and improve the
      health and quality of life of morbidly obese adults, at least in the short term. However,
      bariatric surgery also presents substantial risks, including a 10% to 20% risk of serious
      complications and up to a 2% risk of death in the first 30 days after surgery. Thus, a
      morbidly obese patient's decision regarding bariatric surgery should be based on his or her
      evaluation of accurate information on the possible risks and benefits of the various
      treatment options. Anecdotal reports suggest that bariatric treatment decisions may be more
      heavily influenced by insurance coverage and reimbursement rates than patient preferences.

      The main objective of the current proposal is to examine the impact of a bariatric decision
      aid, Weight loss surgery: Is it right for you?, on decision quality in primary care and
      bariatric specialty practice settings. We propose a randomized controlled trial to assess the
      effect of this bariatric decision aid on bariatric-specific measures of patient knowledge,
      values and choice of weight management strategy. We will also investigate the effect of the
      decision aid on decisional conflict and decisional self-efficacy and examine medical,
      psychological, and behavioral factors as mediators and moderators of treatment choice. This
      information will help to elucidate the value of this decision aid in improving decision
      quality.

      The primary aims of this of this research are to:

        1. Determine if the bariatric decision aid results in superior bariatric surgery decision
           quality than an NIH booklet on weight loss surgery ('usual care').

        2. Determine if the bariatric decision aid results in less decisional conflict and superior
           decisional self-efficacy than usual care.

        3. Determine if there is a differential effect of the interventions on decision quality
           among treatment seekers and non-treatment seekers.

        4. Investigate medical, psychological, and behavioral factors as mediators of treatment
           choice.

      The secondary aims of this study are to:

        1. Understand the current weight control attitudes and practices among morbidly obese
           patients who are not actively seeking bariatric surgical treatment.

        2. Assess the rates of bariatric surgery, health care costs, health care use and outcomes,
           and changes in BMI over time across the intervention groups, as well as across study
           subgroups, such as those who did and did not choose to have bariatric surgery.

      We hypothesize that the decision aid will result in greater knowledge and greater values
      concordance, less decisional conflict and superior decisional self-efficacy than the NIH
      booklet.
    


Intervention name(s): Video Decision Aid; Booklet Decision Aid
Intervention type(s): Other; Other
Intervention description(s): Participants randomized to the video decision aid group will be asked to view the video portion of the decision aid, Weight loss surgery: Is it right for you? in a private room The content of the video and accompanying booklet was based on a systematic-review of the efficacy and safety of bariatric surgery, input from experts in bariatric surgery, internal medicine, psychology, nutrition, and nursing, and from a series of focus groups and interviews with 30 morbidly obese patients, some of whom had elected not to have bariatric surgery.; General educational booklet on gastrointestinal surgery developed by the NIH titled, 'Gastrointestinal Surgery for Severe Obesity'.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research