Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study. Surg Obes Relat Dis 2016 May;12(4):893-901
Date
03/08/2016Pubmed ID
26948943Pubmed Central ID
PMC8356198DOI
10.1016/j.soard.2015.11.028Scopus ID
2-s2.0-84959422636 (requires institutional sign-in at Scopus site) 54 CitationsAbstract
BACKGROUND: Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization.
OBJECTIVES: To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral.
SETTING: Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin.
METHODS: PCPs were asked to discuss prioritization of treatment for a severely obese patient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified.
RESULTS: Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery.
CONCLUSION: Decision making by PCPs for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons.
Author List
Funk LM, Jolles SA, Greenberg CC, Schwarze ML, Safdar N, McVay MA, Whittle JC, Maciejewski ML, Voils CIAuthor
Jeffrey Whittle MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Attitude of Health PersonnelBariatric Surgery
Clinical Decision-Making
Female
Humans
Male
Middle Aged
Obesity, Morbid
Patient Acceptance of Health Care
Patient Care Planning
Physician-Patient Relations
Physicians, Primary Care
Practice Patterns, Physicians'
United States
