Development of a Shared Decision-Making Tool for Obesity Management

Introduction: Obesity is a major public health problem with an exponentially increasing global prevalence. Management of obesity is complex and requires navigation through multiple therapeutic options. Shared medical decision-making (SDM) between patients and providers has been found to improve health outcomes and reduce decisional conflict between parties and can be improved by use of a SDM tool. Methods: We used the See-Plan and Act-Refine-Communicate (SPARC) Framework to create a web-based SDM tool for use by patients, clinicians, and other health professionals during clinical encounters. Development included review of evidence on obesity management, review by experts, observation of usual care (UC), creation, field-testing, and iterative development of this tool in clinical settings. Results: The initial prototype was designed with extensive literature review. The tool covers 3 categories of obesity management (lifestyle modifications, antiobesity medications, bariatric surgery and endobariatric procedures). For each category, it reports the average expected weight loss based on weight entered by user, both in kg/lbs and percentages. It also covers the adverse events, additional health benefits (cardiovascular- and glycemia-related), daily routine and cost of several options in each category (Figure 1). This was reviewed by 3 physicians and 1 pharmacist specializing in the field of obesity. A focus group of 8 research professionals in the field of obesity was convened to review the tool as well. The tool was subsequently improved by observation of live clinical encounters. Feedback about the utility of the tool was sought from 5 patients during a first-time visit for weight management. With field-testing, 3 successive iterations were made before finalizing the prototype. Conclusion: We successfully created a web-based SDM tool to discuss weight management in patients with obesity. Next steps involve evaluating the tool in a real-world clinical setting with a variety of health professionals and the impact on patient-important outcomes.Figure 1.: Sample photos of Shared Medical Decision-making Tool for Obesity Management.