A Comparison of Health Professionals' and Patients' Views of the Importance of Outcomes of Bariatric Surgery

Karen D Coulman, Noah Howes, James Hopkins, Katie Whale, Katy Chalmers, Sara Brookes, Alex Nicholson, Jelena Savovic, Yasmin Ferguson, Amanda Owen-Smith, Jane Blazeby, By-Band-Sleeve Trial Management Group, Jane Blazeby, Richard Welbourn, James Byrne, Jenny Donovan, Barnaby C Reeves, Sarah Wordsworth, Robert Andrews, Janice L Thompson, Graziella Mazza, Chris A Rogers, Karen D Coulman, Noah Howes, James Hopkins, Katie Whale, Katy Chalmers, Sara Brookes, Alex Nicholson, Jelena Savovic, Yasmin Ferguson, Amanda Owen-Smith, Jane Blazeby, By-Band-Sleeve Trial Management Group, Jane Blazeby, Richard Welbourn, James Byrne, Jenny Donovan, Barnaby C Reeves, Sarah Wordsworth, Robert Andrews, Janice L Thompson, Graziella Mazza, Chris A Rogers

Abstract

Background: A comprehensive evaluation of bariatric surgery is required to inform decision-making. This will include measures of benefit and risk. It is possible that stakeholders involved with surgery value these outcomes differently, although this has not previously been explored. This study aimed to investigate and compare how professionals and patients prioritise outcomes of bariatric surgery.

Methods: Systematic reviews and qualitative interviews created an exhaustive list of outcomes. This informed the development of a 130-item questionnaire, structured in four sections (complications of surgery; clinical effectiveness; signs, symptoms, and other measures; quality of life). Health professionals and patients rated the importance of each item on a 1-9 scale. Items rated 8-9 by at least 70 % of the participants were considered prioritised. Items prioritised in each section were compared between professionals and patients and interrater agreement assessed using kappa statistics (ĸ).

Results: One hundred sixty-eight out of four hundred fifty-nine professionals (36.6 %) and 90/465 patients (19.4 %) completed the questionnaire. Professionals and patients prioritised 18 and 25 items, respectively, with 10 overlapping items and 23 discordant items (ĸ 0.363). Examples of items prioritised by both included 'diabetes' and 'leakage from bowel joins'. Examples of discordant items included 're-admission rates' (professionals only) and 'excess skin' (patients only). Poor agreement was seen in the 'quality of life' section (0 overlapping items, 8 discordant, ĸ -0.036).

Conclusions: Although there was some overlap of outcomes prioritised by professionals and patients, there were important differences. We recommend that the views of all relevant health professionals and patients are considered when deciding on outcomes to evaluate bariatric surgery.

Keywords: Core outcome sets; Health professional views; Outcomes; Patient views; Quality of life; Survey.

Conflict of interest statement

Compliance with Ethical Standards Statements Regarding Ethics and Consent All procedures performed in this study were in accordance with the ethical standards of the UK National Research Ethics Service and with the 1964 Declaration of Helsinki and its later amendments. Full ethical approval for the study was obtained from Southwest-Frenchay Research Ethics Committee (reference 11/SW/0248). Written informed consent was obtained from all individual patients included in the study. Conflict of Interest Karen D. Coulman was funded to undertake this research by a National Institute for Health Research (NIHR) Doctoral Research Fellowship. Jelena Savovic’s time was partly supported by a NIHR Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West). Additional funding for the research was provided by the NIHR’s Health Technology Assessment Programme, as part of the By-Band-Sleeve Trial (HTA–09/127/53). This work was also undertaken with the support of the Medical Research Council (MRC) ConDuCT-II Hub (Collaboration and Innovation for Difficult and Complex Randomised Controlled Trials in Invasive Procedures–MR/K025643/1). The views and opinions expressed in this publication are those of the author(s) and do not necessarily reflect those of the National Health Service, the NIHR, the Department of Health, or the MRC. The other authors have no conflicts of interests to declare.

Figures

Fig. 1
Fig. 1
Identifying and grouping outcomes of bariatric surgery into domains for a questionnaire study
Fig. 2
Fig. 2
An example questionnaire item

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Source: PubMed

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