Bailey Karen, Cunningham Charles, Pemberton Julia, Rimas Heather, Morrison Katherine M
1 Division of Pediatric Surgery, Department of Surgery, McMaster Children's Hospital , Hamilton, Ontario, Canada .
2 McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University , Hamilton, Ontario, Canada .
Child Obes. 2015 Dec;11(6):696-706. doi: 10.1089/chi.2015.0031. Epub 2015 Nov 18.
Although most clinicians agree that obesity is a major problem, treatment rates remain low. We conducted this discrete choice experiment (DCE) to understand academic clinicians' decisions in treating childhood obesity.
A total of 198 academic pediatric surgeons, pediatricians, family physicians, and allied health professionals were recruited from 15 teaching hospitals across Canada to participate in this DCE. Participants completed 15 tasks choosing between three obesity treatment scenarios to identify the scenario in which they would most likely treat pediatric obesity.
Latent class analysis revealed two classes with early intervention and late intervention preferences. Participants in the early intervention group (30%) were sensitive to variations in patient and family support. They would likely intervene if patients were obese, with normal lipid levels, were prediabetic, had high blood pressure, and when obesity was lifestyle associated. Late intervention clinicians (70%) were more likely to intervene if patients were morbidly obese, had abnormal lipid levels, required insulin for diabetes, had very high blood pressure, or when obesity impacted the patient's mental health. Simulations predicted that increasing colleague support for intervention, providing expert consultation, and mobilizing multidisciplinary support would increase the likelihood of treating pediatric obesity earlier from 16.1% to 81.5%.
This DCE was implemented to understand the factors clinicians use in making decisions. Most academic clinicians choose to intervene late in the clinical course when more-severe obesity-related morbidities are present. Increased support from colleagues, expert consultation, and multidisciplinary support are likely to lead to earlier treatment of obesity among academic clinicians caring for children.
尽管大多数临床医生都认同肥胖是一个主要问题，但治疗率仍然很低。我们开展了这项离散选择实验（DCE），以了解学术型临床医生在治疗儿童肥胖症方面的决策。
从加拿大各地的15家教学医院招募了总共198名学术型儿科外科医生、儿科医生、家庭医生和相关健康专业人员，参与这项DCE。参与者完成了15项任务，在三种肥胖治疗方案之间进行选择，以确定他们最有可能治疗儿童肥胖症的方案。
潜在类别分析揭示了两类具有早期干预和晚期干预偏好的人群。早期干预组的参与者（30%）对患者及家庭支持的变化较为敏感。如果患者肥胖、血脂水平正常、处于糖尿病前期、患有高血压且肥胖与生活方式相关，他们可能会进行干预。晚期干预的临床医生（70%）在患者患有严重肥胖症、血脂水平异常、糖尿病需要胰岛素治疗、血压非常高或肥胖影响患者心理健康时，更有可能进行干预。模拟预测，增加同事对干预的支持、提供专家咨询以及动员多学科支持，将使早期治疗儿童肥胖症的可能性从16.1%提高到81.5%。
开展这项DCE是为了了解临床医生在做决策时所考虑的因素。大多数学术型临床医生会在临床病程后期，即出现更严重的肥胖相关并发症时才选择进行干预。来自同事的更多支持、专家咨询和多学科支持可能会促使照顾儿童的学术型临床医生更早地治疗肥胖症。
