Group Health Research Institute, Seattle, Washington, USA.
Obesity (Silver Spring). 2011 Aug;19(8):1669-75. doi: 10.1038/oby.2011.65. Epub 2011 Apr 7.
The decision to have bariatric surgery should be based on accurate information on possible risks and benefits of all treatment options. The goal of this study was to determine whether a video-based bariatric decision aid intervention results in superior decision quality compared to an educational booklet. We conducted a prospective, randomized controlled trial among adult patients in a single health plan who met standard criteria for bariatric surgery. Patients were randomly assigned to review either a video-based decision aid (intervention) or an educational booklet on bariatric surgery (control). Changes in patient decision quality were assessed using bariatric-specific measures of knowledge, values, and treatment preference after 3 months. Of 152 eligible participants, 75 were randomly assigned to the intervention and 77 to the control. The 3-month follow-up rate was 95%. Among all participants, significant improvements were observed in knowledge (P < 0.001), values concordance (P = 0.009), decisional conflict (P < 0.001), decisional self-efficacy (P < 0.001), and in the proportion who were "unsure" of their treatment choice (P < 0.001). The intervention group had larger improvements in knowledge (P = 0.03), decisional conflict (P = 0.03), and outcome expectancies (P = 0.001). The proportion of participants choosing bariatric surgery did not differ significantly between groups, although there was a trend toward decreased surgical choice in the intervention group (59% booklet vs. 42% video at 3 months; P = 0.16). The use of bariatric surgery decision aids was followed by improved decision quality and reduced uncertainty about treatment at 3 months. The video-based decision aid appeared to have a greater impact than the educational booklet on patient knowledge, decisional conflict, and outcome expectancies.
进行减重手术的决定应基于所有治疗方案的可能风险和益处的准确信息。本研究的目的是确定基于视频的减重决策辅助干预是否比教育手册更能提高决策质量。我们在符合减重手术标准的单一健康计划中的成年患者中进行了一项前瞻性、随机对照试验。患者被随机分配至观看基于视频的决策辅助（干预）或减重手术教育手册（对照）。3 个月后，使用减重特定的知识、价值观和治疗偏好措施评估患者决策质量的变化。在 152 名符合条件的参与者中，75 名被随机分配至干预组，77 名被分配至对照组。3 个月的随访率为 95%。在所有参与者中，知识（P < 0.001）、价值观一致性（P = 0.009）、决策冲突（P < 0.001）、决策自我效能感（P < 0.001）和对治疗选择不确定的比例（P < 0.001）均有显著改善。干预组在知识（P = 0.03）、决策冲突（P = 0.03）和结果预期（P = 0.001）方面的改善更大。两组选择减重手术的参与者比例没有显著差异，但干预组的手术选择呈下降趋势（3 个月时手册组为 59%，视频组为 42%；P = 0.16）。使用减重手术决策辅助后，患者的决策质量得到改善，对治疗的不确定性降低。与教育手册相比，基于视频的决策辅助对患者知识、决策冲突和结果预期的影响更大。
