Barriers to shared decision-making for bariatric surgery identified
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A study published in Obesity identified important barriers to shared decision-making around bariatric surgery among adults with severe obesity requiring prioritization.
“We aimed to refine, deploy and rigorously evaluate a multicomponent strategy for shared decision-making implementation to improve decisions around bariatric surgery among patients with severe obesity in both primary and specialty care settings in two U.S.-based health care systems,” David Arterburn, MD, MPH, general internist and senior investigator at Kaiser Permanente Washington Health Research Institute, Seattle, and colleagues wrote.
Researchers identified multidisciplinary teams from the Kaiser Permanente Washington and the University of Pittsburgh Medical Center (UPMC) health care systems. To identify barriers to shared decision-making for bariatric surgery, these teams used a nominal group process approach with generation of multilevel barriers, round-robin recording of barriers, facilitated discussion and selection and ranking of barriers based on importance and feasibility to address. Researchers then used the Exploration, Preparation, Implementation, Sustainment (EPIS) conceptual model to help guide the implementation process.
The Kaiser Permanente Washington health care system identified 13 barriers to shared decision-making around bariatric surgery, with five prioritized as the most important and feasible to address. The UPMC health care system identified 14 barriers and prioritized six.
The most commonly prioritized barriers between these two large U.S. health care systems:
- lack of insurance coverage;
- lack of understanding of insurance coverage;
- lack of organizational prioritization of shared decision-making;
- lack of knowledge about bariatric surgery;
- lack of interdepartmental clarity between primary and specialty care; and
- limited training on shared decision-making conversations and tools.
In addition to these barriers, limited education on the science of obesity and lack of knowledge of weight management resources were reported as the most important and feasible barriers to address by the Kaiser Permanente Washington health care system. The UPMC health care system also reported technical difficulties of adding new tools or features to the electronic health record and the surgeon’s preference around procedure choice as important barriers that are feasible to address.
“As we move forward in this project, implementation strategies that address each of the barriers we prioritized ... will be designed, refined and organized by our clinical leaders into a formal shared decision-making implementation blueprint for each health system,” the researchers wrote. “These blueprints will then guide each team through the Implementation and Sustainment phases of the EPIS model.”
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