Enhancing Shared Decision-Making in Metabolic and Bariatric Surgery: A Multi-System Implementation and Evaluation.

Objective: To enhance shared decision-making (SDM) about metabolic and bariatric surgery (MBS) through the systematic implementation and evaluation of SDM tools across two large healthcare systems. Methods: The project involved developing and integrating SDM tools into clinical workflows at two health systems and training clinicians to use two decision aids with eligible patients. Data were collected using patient surveys, electronic health record (EHR) data, and qualitative interviews with clinicians. The primary outcome was change in patient-reported measures of SDM using the collaboRATE items. Results: Decision aids were delivered to 1675 patients. Implementation was associated with an increase in referrals to MBS and the number of patients undergoing surgery at KPWA but not at UPMC. Baseline levels of SDM quality were high. Post-implementation collaboRATE scores decreased significantly, indicating a perceived decline in SDM quality, but not in two other SDM measures. Qualitative feedback highlighted the challenges and successes of integrating SDM tools into clinical practice. Conclusions: Implementation of SDM tools had mixed results across the sites. Implementation was associated with an increase in referrals and surgery at KPWA but not at UPMC. The perceived quality of SDM conversations also declined. Future efforts should focus on incorporating all weight management options, including medications and lifestyle interventions.