PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is using results from a recent study comparing the benefits and harms of weight loss surgery to support patients in making informed decisions about their care.

Some people with severe obesity can’t lose enough weight with diet and exercise to improve their health and quality of life. Two types of weight-loss surgery can help people with severe obesity lose weight and improve problems related to obesity, such as diabetes. Patients can work with their clinicians to consider the risks and benefits of these surgeries and make the decisions that work best for them.

What is the goal of this implementation project?

Shared decision making, or SDM, is a process in which patients and doctors work together to make healthcare decisions. A PCORI-funded research study followed more than 46,000 people with severe obesity who had weight loss surgery for five years. Depending on which surgery people chose, the study found differences in how much weight they lost after surgery, whether their diabetes improved, and whether people had another surgery.

This project is bringing the results of this study to patients who are thinking about weight loss surgery and their doctors to help them make a decision.

What will this project do?

The project team is working with weight loss, diabetes, and primary care clinics. These clinics are part of two large health systems in Washington State and Pennsylvania.

First the project team is updating two decision aids, called Option Grids, with the results from the study. Decision aids help people choose treatments based on what’s most important to them. Patients who are thinking about surgery can view the first decision aid before meeting with their clinician to discuss if surgery is right for them. Patients who’ve already decided on surgery can use the second decision aid with their surgeon to discuss which type of surgery to get.

The project team is forming local teams at each site that will:

• Help design approaches to make the decision aids and SDM discussions part of routine care at each site
• Oversee all activities and support care teams at their sites
• Refine the training program for use at the sites

The project team is also:

• Working with site leadership to make SDM a routine part of care for patients who are thinking about weight loss surgery
• Training clinicians or surgeons at each site as clinical champions who can promote SDM
• Providing in-person and virtual training on SDM, including role-playing
• Working with sites to build processes into their IT systems for ordering decision aids, referring patients to specialists, and documenting use of the decision aids
• Working with sites to provide monthly reports for clinicians that capture use of decision aids, referrals, and patients’ choice of procedures

What is the expected impact of this project?

This project will demonstrate what’s required to put the SDM process into practice at two health systems. More than 1,800 patients with severe obesity will receive support when making decisions about weight loss surgery.

The project evaluation will confirm that the process is working as intended to support SDM for patients who are thinking about surgery.

More about this implementation project: