BACKGROUND: Randomized trials of bariatric surgery versus lifestyle treatment likely enroll highly motivated patients, which may limit the interpretation and generalizability of study findings. The objective of this study was to assess the feasibility of a population-based shared decision-making (SDM) approach to recruitment for a trial comparing laparoscopic Roux-en-Y gastric bypass surgery with intensive lifestyle intervention among adults with mild to moderate obesity and type 2 diabetes. METHODS:Adult members with a body mass index (BMI) between 30 and 45 kg/m(2) taking diabetes medications were identified in electronic databases and underwent a multiphase screening process. Candidates were given a telephone survey, education about treatment options for obesity and diabetes using decision aids, and an SDM phone call with a nurse practitioner, in addition to standard office-based consent. RESULTS: We identified 1808 members, and 828 (45.7%) had a BMI of 30-34.9 kg/m(2). Among these, 1063 (59%) agreed to the telephone survey, 416 (23%) expressed interest in education about treatment options, and 277 (15%) completed the SDM process. The preferred treatment options were surgery (21 [8%]), diet and exercise (149 [53.8%]), pharmacotherapy (5 [2%]), none of the above (8 [3%]), and unsure (94 [34%]). Ultimately, 43 participants were randomly assigned to the trial. Significant differences, mainly related to sex, disease severity, and hypoglycemic medication use, were observed among people who did and did not agree to participate in our trial. CONCLUSION: This population-based, SDM-based recruitment strategy successfully identified, enrolled, and randomly assigned patients who had balanced views of surgery and lifestyle management. Even with this approach, selection biases may remain, highlighting the need for careful characterization of nonparticipants in all future studies.
RCT Entities:
BACKGROUND: Randomized trials of bariatric surgery versus lifestyle treatment likely enroll highly motivated patients, which may limit the interpretation and generalizability of study findings. The objective of this study was to assess the feasibility of a population-based shared decision-making (SDM) approach to recruitment for a trial comparing laparoscopic Roux-en-Y gastric bypass surgery with intensive lifestyle intervention among adults with mild to moderate obesity and type 2 diabetes. METHODS: Adult members with a body mass index (BMI) between 30 and 45 kg/m(2) taking diabetes medications were identified in electronic databases and underwent a multiphase screening process. Candidates were given a telephone survey, education about treatment options for obesity and diabetes using decision aids, and an SDM phone call with a nurse practitioner, in addition to standard office-based consent. RESULTS: We identified 1808 members, and 828 (45.7%) had a BMI of 30-34.9 kg/m(2). Among these, 1063 (59%) agreed to the telephone survey, 416 (23%) expressed interest in education about treatment options, and 277 (15%) completed the SDM process. The preferred treatment options were surgery (21 [8%]), diet and exercise (149 [53.8%]), pharmacotherapy (5 [2%]), none of the above (8 [3%]), and unsure (94 [34%]). Ultimately, 43 participants were randomly assigned to the trial. Significant differences, mainly related to sex, disease severity, and hypoglycemic medication use, were observed among people who did and did not agree to participate in our trial. CONCLUSION: This population-based, SDM-based recruitment strategy successfully identified, enrolled, and randomly assigned patients who had balanced views of surgery and lifestyle management. Even with this approach, selection biases may remain, highlighting the need for careful characterization of nonparticipants in all future studies.
Authors: James N Weinstein; Tor D Tosteson; Jon D Lurie; Anna N A Tosteson; Brett Hanscom; Jonathan S Skinner; William A Abdu; Alan S Hilibrand; Scott D Boden; Richard A Deyo Journal: JAMA Date: 2006-11-22 Impact factor: 56.272
Authors: John B Dixon; Paul E O'Brien; Julie Playfair; Leon Chapman; Linda M Schachter; Stewart Skinner; Joseph Proietto; Michael Bailey; Margaret Anderson Journal: JAMA Date: 2008-01-23 Impact factor: 56.272
Authors: David Reed Flum; Steven H Belle; Wendy C King; Abdus S Wahed; Paul Berk; William Chapman; Walter Pories; Anita Courcoulas; Carol McCloskey; James Mitchell; Emma Patterson; Alfons Pomp; Myrlene A Staten; Susan Z Yanovski; Richard Thirlby; Bruce Wolfe Journal: N Engl J Med Date: 2009-07-30 Impact factor: 91.245
Authors: David E Cummings; David E Arterburn; Emily O Westbrook; Jessica N Kuzma; Skye D Stewart; Chun P Chan; Steven N Bock; Jeffrey T Landers; Mario Kratz; Karen E Foster-Schubert; David R Flum Journal: Diabetologia Date: 2016-03-17 Impact factor: 10.122
Authors: Anita P Courcoulas; James W Gallagher; Rebecca H Neiberg; Emily B Eagleton; James P DeLany; Wei Lang; Suriya Punchai; William Gourash; John M Jakicic Journal: J Clin Endocrinol Metab Date: 2020-03-01 Impact factor: 5.958
Authors: Donald C Simonson; Bo Hu; David E Arterburn; Philip R Schauer; Sangeeta R Kashyap; Anita P Courcoulas; David E Cummings; Mary-Elizabeth Patti; William F Gourash; Ashley H Vernon; John M Jakicic; John P Kirwan Journal: Diabetes Obes Metab Date: 2022-03-16 Impact factor: 6.408
Authors: Manish Parikh; Mimi Chung; Sheetal Sheth; Michelle McMacken; Tasneem Zahra; John K Saunders; Aku Ude-Welcome; Van Dunn; Gbenga Ogedegbe; Ann Marie Schmidt; H Leon Pachter Journal: Ann Surg Date: 2014-10 Impact factor: 12.969
Authors: David Arterburn; Robert Wellman; Ana Emiliano; Steven R Smith; Andrew O Odegaard; Sameer Murali; Neely Williams; Karen J Coleman; Anita Courcoulas; R Yates Coley; Jane Anau; Roy Pardee; Sengwee Toh; Cheri Janning; Andrea Cook; Jessica Sturtevant; Casie Horgan; Kathleen M McTigue Journal: Ann Intern Med Date: 2018-10-30 Impact factor: 25.391