Patient preferences and bariatric surgery procedure selection; the need for shared decision-making.
BACKGROUND
Bariatric surgery is the most effective treatment for patients suffering from obesity-related comorbidities. There is little data regarding how patients choose one particular bariatric procedure over another. This study aimed to better define the relationship between preferences of patients considering bariatric surgery and the procedure patients undergo.


METHODS
A bilingual questionnaire was administered to all prospective patients seen between March 1 and August 31, 2012. The questionnaire assessed basic knowledge of bariatric surgery (based on the information seminar) as well as patient preferences of the various outcomes and complications for sleeve gastrectomy, gastric bypass, and gastric banding.


RESULTS
One hundred seventy-two patients completed the questionnaire. Fifty-eight percent of patients chose "maximum weight loss" as the most important outcome, and 65 % chose "leak" as the most concerning complication. Subgroup analysis of patients with diabetes revealed that 58 % chose "curing diabetes" as the most important outcome. Nineteen percent of patients were either not sure which procedure they wanted or changed their decision after consultation with the surgeon.


CONCLUSIONS
The decision to choose one bariatric procedure over another is complex and is based on factors beyond absolute patient preferences. Although maximum weight loss is a commonly reported preference for patients seeking bariatric surgery, patients with diabetes are more focused on diabetes remission. Most patients have already decided which procedure to undergo prior to surgeon consultation. Patients may benefit from shared decision making, which integrates patient values and preferences along with current medical evidence to assist in the complex bariatric surgery selection process.
Department of Surgery, New York University Langone Medical Center, Bellevue Hospital Center, 550 First Avenue, NBV 15 South 7, New York, NY, 10016, USA, alwmed@gmail.com.
Andrew L
AL
Weinstein
Bryan J
BJ
Marascalchi
Matthew A
MA
Spiegel
John K
JK
Saunders
Angela
A
Fagerlin
Manish
M
Parikh
D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D057240:Patient Preference; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires