肥満と減量療法のジャーナル

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A Decision Aid Intervention to Improve Decisions about Weight Management Referral in Primary Care: Development and Feasibility Study

Ian Brown and Michelle Deighton

Patient non-attendance after referral to weight management support is a problem in routine health care. The decision making process prior to referral is a useful focus for research. The present study aimed to develop a patient decision aid intervention and to investigate patient and clinician perspectives on its acceptability and implementation in primary care. The content of a decision aid booklet was developed following in-depth interviews with 52 adults (mean age 56 years; 26 women, 26 men). The content was refined within a study of patients (n=21, 15 women) and clinicians (n=45) comprising doctors (n=12), nurses (n=15) and allied professions (n=18). An exploratory study of implementation was undertaken in primary care with feedback obtained from 18 patients (mean age 52 years; 12 women) and 5 nurses in relation to weight review consultations. Study findings show the weight management decision process is potentially complex and challenging to patients for both cognitive and social reasons. A decision aid developed to address patient needs was liked by patients and, to a lesser extent, by clinicians. The intervention was viewed as acceptable and feasible for implementation into routine practice. Active ingredients within a complex intervention appeared to be improvements in cognitive processing for patients but also improvements in rapport between patient and clinician. Further research should now evaluate outcomes including consultation rapport and patient attendance.