There are significant differences between patients and healthcare practitioners, as well as between pre- and post-surgical groups, and medical & allied health practitioners, with regards to patient-reported outcomes (PROMs) according to findings from a modified Delphi study by researchers from Australia and New Zealand.
The study authors reported that there was considerable agreement between stakeholder groups on many outcomes however, they identified several outcomes with that disagreed upon. For example, they highlighted that healthcare practitioners prioritised 20 outcomes that were not prioritised by patients, emphasising the range of priorities across stakeholder groups.
Although PROMS are an important emerging metric increasingly utilised in clinical, research and registry settings, they are underutilised and require refinement for the specific patient population of those undergoing bariatric surgery, the researchers noted. The Australian and New Zealand Bariatric Surgery Registry (ANZ BSR) is currently developing a PROM to incorporate patient outcomes in its data collection.
As a first step in this project, they designed a study to investigate and compare how pre-surgical patients, post-surgical patients, and healthcare practitioners evaluate patient-reported outcomes of bariatric surgery to identify outcomes that are considered most important. This included an ‘Outcome Importance Questionnaire’ that contained 68 items across ten domains including; (1) General Health; (2) Eating Symptoms; (3) Sleep; (4) Sex; (5) Perception of Surgery; (6) General Quality of Life; (7) Social Activity; (8) Mental Health & Emotional Well-Being; (9) Eating Behaviour & Relationship to Food; and (10) Self-Esteem & Body Image.
The questionnaire was sent to all surgeons and healthcare practitioners based in Australia who contributing to the ANZ BSR and was also distributed by the Australian and New Zealand Metabolic & Obesity Surgery Society (ANZMOSS) to target additional allied health practitioners. Pre-surgical patients were recruited via participating healthcare practitioners and post-surgical patients randomly selected from the ANZ BSR.
Outcomes
A total of 313 participants took part in the study including 48 pre-surgical patients, 180 post-surgical patients and 85 healthcare practitioners (Including 36 surgeons).
The researchers reported that there were significant differences between pre- and post-surgical patients and healthcare professionals for satisfaction with quality of life (85.0% vs. 85.3% and 96.4%, p<0.026), satisfaction with surgery (85.0% vs. 86.3% and 92.9%, p<0.043), weight/surgery-specific symptoms such as vomiting, regurgitation, heartburn, nausea, shortness of breath (70.0% vs. 73.7% and 92.9%, p<0.049), overall mental health (90.0% vs. 80.0% and 89.3%, p<0.027), satisfaction with sleep (80.0% vs. 75.8% and 46.4%, p<0.004), energy levels/fatigue (90.0% vs. 60.0% and 85.7%, p<0.020), physical signs such as hair loss, teeth or gum problems, loss of sensation in hands and feet, skin irritations (80.0% vs. 42.1% and 82.1%, p<0.001) and level of pain (55.0% vs. 89.5% and 75.0%, p<0.019).
Survey participants were asked to rank the overall domains from the most important to the least important. All the groups agreed that general health and general quality of life were most important (p<0.027), with the perception of surgery the least important (p<0.742).
“Additional research is needed to identify how, why, and when these priorities change and whether this is an impact of bariatric surgery or simply a change in perspective as people age. These differences highlight the potential for patient subgroups to place a higher value on certain outcomes compared to the consensus,” the authors emphasised. “As the work continues, it will be important to identify any subgroups that may experience distinct outcomes affecting their health and well-being post-surgery, including patients from diverse ethnic, gender, and socioeconomic backgrounds. This could prove important in identifying patients experiencing poor outcomes post-surgery to provide enhanced, and individualised patient care.”
The authors noted that this research emphasises the range of priorities represented across these groups and the need for any core outcome set or PROM to consider these priorities.
The findings were reported in the paper, ‘Patient and healthcare practitioner evaluation of patient-reported outcomes in bariatric surgery – a modified Delphi study’, published in the International Journal of Obesity. To access this paper, please click here
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