Preferences for Bariatric Surgery: Comparing Surgeons and Patients Using a Discrete Choice Experiment

Background: Increased attention to shared decision-making is particularly important in bariatric surgery. It is unclear whether the large shift toward sleeve gastrectomy is evidence of good alignment between patient and surgeon preferences.

Objective: To identify surgeon preferences for risks, benefits, and other attributes of treatment options available for bariatric surgery and to compare results with patient preferences.

Setting: Online survey.

Methods: A discrete choice experiment of weight loss procedures. Each procedure was described by the following set of attributes: (1) treatment method, (2) recovery and reversibility, (3) years treatment has been available, (4) expected weight loss, (5) effect on other medical conditions, (6) risk of complication, (7) side effects, (8) changes to diet, (9) out-of-pocket costs. Participants chose between surgical profiles by comparing attributes. A convenience sample of providers for the online survey was recruited via LISTSERVs of professional associations.

Results: Respondents (n = 121) were most likely to select profiles of hypothetical procedures based on the resolution of existing medical conditions and higher expected weight loss. These results align with patient preferences. However, surgeons selected profiles based on lower risk of complications than did patients and surgeons were less sensitive to out-of-pocket costs than patients.

Conclusions: Results show strong alignment between the preferences of patients and the preferences of surgeons when they are asked to stand in the place of their patients. Some differences, especially those related to sensitivity to risk of complications and out-of-pocket costs indicate that shared decision-making would benefit from providers explaining their concerns about surgical risk and from appreciating the concern many patients have about financial costs.