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Patient-provider discussions about surgery play pivotal role in outcomes

Fri, 06/11/2021 - 09:25
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Investigators from Brigham and Women's Hospital have reported that eligible patients who discuss bariatric surgery options with their primary care providers or specialists from disciplines ranging from cardiology to urology, are more likely to undergo surgery and lose more weight than those who do not have such discussions. However, the team also found that these pivotal discussions were exceedingly rare, with fewer than 10 percent of eligible patients having a conversation over the course of a year. The outcomes were featured in the paper, ‘Patient-provider discussions of bariatric surgery and subsequent weight changes and receipt of bariatric surgery’, was published in Obesity.

"Obesity is a very significant health problem in the United States and increases the risk of almost every disease, from heart disease to diabetes and kidney failure," said Dr Alexander Turchin, Division of Endocrinology, Diabetes and Hypertension. "The most effective treatment for people with severe obesity is weight loss surgery. However, fewer than 1 percent of eligible patients every year undergo these operations in the US. We wanted to explore why that is."

Turchin and colleagues conducted an observational study from 2000 to 2015, collecting data from 30,560 patients with obesity. They looked at the frequency of patient-provider conversations about bariatric surgery and correlated patient weight-loss outcomes. Researchers analysed clinicians' electronic notes through artificial intelligence, using natural language processing (NLP) software, and searched for provider documentation of conversations about bariatric surgery.

Out of 30,560 study patients, a total of 2,659 (8.7%) of potentially eligible patients had discussions about bariatric surgery with their providers. Patients who had these discussions were ten times more likely to undergo weight loss surgery than those who did not (10.2; 95% CI: 9.0-11.6; p < 0.001) of undergoing bariatric surgery. Patients who engaged in these conversations were also more likely to lose weight over time, even without surgery (BMI reduction of 2.18 vs 0.21 for patients who did not, p<0.001), and lost more weight than patients who did not talk with their providers about surgery options at all.

The authors noted that one limitation of this study is that they do not know who initiated these discussions. In some cases, the providers may have first brought up bariatric surgery, while in others, patients may have first asked questions about it.

"Even without surgery, such discussions emphasize the seriousness of obesity and may prompt patients to explore ways to lose weight," he said. "It's important for clinicians to initiate these discussions but also support them when patients bring them up themselves."

Looking forward, Turchin's team aims to investigate which medical specialists are most likely to have these discussions and evaluate whether prompting these conversations is an effective intervention for weight-related illnesses.

"Usually, when we talk about clinical outcomes, we look at whether we changed a patient's medication or started a new treatment," said Turchin. "What we miss, though, is that the first step in reaching a treatment goal is to talk to the patient. We need to talk to our patients more about the options available and help them to become better informed about their care."

Funding for this work was provided by the National Institutes of Health/National Heart Lung and Blood Institute (2T32HL007609-32) and the Patient-Centered Outcomes Research Institute (ME-2019C1-15328)