MedicalResearch.com Interview with:
Michael Rozier, S.J., Ph.D.
Assistant Professor, Health Management and Policy
College for Public Health and Social Justice
St. Louis University
MedicalResearch.com: What is the background for this study?
Response: Patients considering surgery for weight loss have several options, which differ in significant ways, such as expected weight loss, risk of complication, modification of diet, effect on other medical conditions, and more. Previous studies have asked patients why they chose one procedure over another.
Instead, we quantified the relative importance of the key characteristics of surgical options. Using a discrete choice experiment, potential patients were given profiles of two weight loss options. They were asked to select one profile based on key characteristics such as out-of-pocket costs, total weight loss, risk of complication, and five other factors.
MedicalResearch.com: What are the main findings?
Response: Patients considering bariatric surgery place the greatest value on overall weight loss, out-of-pocket costs, and resolution of medical conditions. When forced to make a trade-off, they are less concerned with risk of complication and time for recovery. There are small differences in priorities across gender, age, and income level. For example, younger respondents were more sensitive to out-of-pocket costs and were more likely to prioritize higher weight loss. In general, however, preferences are consistent across demographic groups. Latent class analysis identified three subgroups of patients that did not fall along demographic lines: cost-sensitive; benefit-focused (most concerned with weight loss and resolution of medical conditions); and procedure-focused (most concerned with how the treatment works, including recovery and reversibility).
MedicalResearch.com: What should readers take away from your report?
Response: We often don’t understand how and why we make trade-offs. In this study, we were able to quantify and make explicit what potential patients often leave as implicit. Better data helps patients surface what their highest priorities in care actually are. For example, for those considering bariatric surgery, out-of-pocket cost is clearly a major factor, but we have given providers very few resources how they can discuss this factor with their patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Two brief points. First, we have a follow-up study that investigates the preferences of bariatric surgeons with this same technique. Generating comparative data to better understanding the patient-provider relationship is always important. Second, bariatric surgery has already evolved since we field this survey, which is evidence we need to invest in more nimble research infrastructure.
We would like to reiterate the acknowledgements listed in the manuscript. No disclosures beyond what is published.
Rozier MD, Ghaferi AA, Rose A, Simon N, Birkmeyer N, Prosser LA. Patient Preferences for Bariatric Surgery: Findings From a Survey Using Discrete Choice Experiment Methodology. JAMA Surg. Published online November 28, 2018. doi:10.1001/jamasurg.2018.4375
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