Understanding How Patients Value Bariatric Surgery

虽然减肥手术是为数不多的有效的长期治疗肥胖的方法之一，但它既不是无风险的， 普遍有效。与手术相关的费用和围绕手术相关死亡的宣传 并且并发症使得许多临床医生和患者对这种潜在的有效治疗感到矛盾。 尽管这种手术越来越受欢迎，但只有一小部分符合医学条件的患者接受减肥治疗。 手术此外，非洲裔和西班牙裔美国人以及社会经济弱势群体似乎 不太可能接受这种治疗。这些使用变化是否主要由患者驱动 偏好或健康差异尚不清楚。 许多因素，包括病人的动机和期望影响病人的决定，减肥 手术的好处是否可能超过它的风险。肥胖对身体和 心理社会后果可能导致一些患者更重视生活质量（QOL）益处，而不是临床 不切实际的期望可能导致其他人接受高于合理手术风险的手术 即使是最好的结果也不满意。本项目的目标是：1）更好地了解 患者对减肥的偏好和价值以及减肥手术的结果和2）识别障碍 以及影响那些尚未承诺接受这种治疗的人的决策的因素。 该项目将使用健康效用评估来检查减肥和减肥手术的价值， 量化患者如何评价不同健康结果的有效方法，使患者能够考虑所有 对他们来说很重要的因素。该项目将包括两个不同的群体。调查人员将招募和 采访了来自两个减肥中心的650名患者，并随访了那些（n~450）进行手术的患者， 评估其效用、QOL和随时间推移的临床结局。这样做，他们可以量化患者的价值， 通过确定公用事业的变化来进行减肥手术;他们也将能够检查 和预测更高价值的结果。此外，他们还将采访600名社会人口学上不同的人， 来自一家医院和三个社区诊所的初级保健患者，检查他们对减肥的看法 和减肥手术，并确定偏好和障碍，可能解释目前的治疗变化。 该项目的发现将提高我们对患者如何评价减肥手术及其 不同的结果，并可能有助于确定那些最有可能受益于手术。该项目还将 提供指导更准确的减肥决策和成本效益分析所需的实用数据 手术最后，研究结果将使患者和临床医生做出更明智的决定 关于减肥手术符合患者的喜好，并帮助制定干预措施和政策 这些变化可能会减少减肥手术治疗中的种族和其他差异。

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.