Understanding How Patients Value Bariatric Surgery

描述(申请人提供)：虽然减肥手术是为数不多的有效的长期肥胖治疗方法之一，但它既不是无风险的，也不是普遍有效的。与手术相关的费用和围绕手术相关死亡和并发症的宣传费用让许多临床医生和患者对这种潜在有效的治疗方法感到矛盾。尽管这项手术越来越受欢迎，但只有一小部分符合医学条件的患者接受了减肥手术。此外，非洲裔和西班牙裔美国人以及在社会经济上处于不利地位的人似乎不太可能接受这种待遇。目前尚不清楚这些使用上的差异主要是由患者的喜好还是健康差异造成的。包括患者动机和期望在内的许多因素影响着患者对减肥手术的决定，以及手术的好处是否可能超过其风险。肥胖的深远的生理和心理社会后果可能会导致一些患者更看重生活质量(QOL)的好处，而不是临床好处，而不切实际的期望可能会导致其他人接受比合理的手术风险更高的风险，并对即使是最好的结果感到不满。该项目的目标是1)更好地了解患者对减肥和减肥手术结果的喜好和价值，以及2)确定影响那些尚未致力于这种治疗的人做出决定的障碍和因素。这个项目将使用健康效用评估来检验减肥和减肥手术的价值，这是一种量化患者如何评估不同健康结果的有效手段，使患者能够考虑对他们来说重要的所有因素。该项目将包括两个不同的群体。研究人员将从两个减肥中心招募并采访650名患者，并跟踪那些继续进行手术的患者(n~450人)，以评估他们的效用、生活质量和随着时间的推移的临床结果。通过这样做，他们可以通过确定效用的变化来量化患者对减肥手术的价值；他们还将能够检查预测更高价值的因素和结果。此外，他们将采访来自一家医院和三家社区诊所的600名社会人口统计学上不同的初级保健患者，以检查他们对减肥和减肥手术的看法，并确定可能解释当前治疗差异的偏好和障碍。这个项目的发现将提高我们对患者如何评价减肥手术及其不同结果的理解，并可能有助于确定哪些人最有可能从手术中受益。该项目还将提供所需的实用数据，以指导更准确的减肥手术决策和成本效益分析。最后，这项研究的结果将使患者和临床医生能够根据患者的偏好做出更明智的减肥手术决定，并有助于形成干预措施和政策变化，可能会减少减肥手术治疗中的种族和其他差异。

DESCRIPTION (provided by applicant): While bariatric surgery is one of few effective long-term treatments for obesity, it is neither risk-free nor universally effective. The costs associated with surgery and publicity surrounding surgery-related deaths and complications have left many clinicians and patients ambivalent about this potentially effective treatment. Despite the surgery's rising popularity, only a small fraction of medically eligible patients undergo bariatric surgery. Moreover, African and Hispanic Americans and the socioeconomically disadvantaged appear to be less likely to receive this treatment. Whether these variations in use are primarily driven by patient preferences or health disparities is unclear. Many factors including patient motivation and expectation impact patients' decisions about bariatric surgery and whether the benefits of surgery might outweigh its risks. Obesity's profound physical and psychosocial consequences may lead some patients to value quality of life (QOL) benefits more than clinical benefits whereas unrealistic expectations may cause others to accept higher than reasonable surgical risks and be dissatisfied with even the best outcomes. The goals of this project are 1) to better understand patients' preferences and value for weight loss and outcomes of bariatric surgery and 2) to identify barriers and factors that influence decision-making among those not already committed to this treatment. This project will examine the value of weight loss and bariatric surgery using health utility assessment, a valid means of quantifying how patients value different health outcomes that allows patients to consider all factors important to them. The project will include two distinct populations. The investigators will recruit and interview 650 patients from two bariatric centers and follow those (n~450) who proceed with surgery to assess their utility, QOL, and clinical outcomes over time. In doing so, they can quantify the value patients place on bariatric surgery by determining the change in utilities; they will also be able to examine the factors and outcomes that predict higher value. In addition, they will interview 600 sociodemographically diverse primary care patients from one hospital and three community practices to examine their views on weight loss and bariatric surgery and identify preferences and barriers that might explain current variations in treatment. Findings from this project will improve our understanding of how patients value bariatric surgery and its different outcomes and may help identify those most likely to benefit from surgery. This project will also provide the utility data needed to guide more accurate decision and cost-effectiveness analyses of bariatric surgery. Finally, findings from the study will allow patients and clinicians to make more informed decisions about weight loss surgery consistent with patient preferences, and help shape interventions and policy changes that might reduce racial and other disparities in bariatric surgical treatment.