肥胖症患者参与减重代谢手术决策类型及影响因素分析

Surgical decision-making types and its influencing factors for obesity patients participating in bariatric metabolic surgery

目的探讨肥胖症患者参与减重代谢手术决策类型及影响因素。方法调查对象为南京医科大学第一附属医院收治的拟行减重代谢手术患者。调查时间为2024年1月1日至5月30日。采用一般资料调查表、决策期待量表、减重代谢手术共享决策支持需求问卷对患者进行调查。计数资料以绝对数和百分比表示, 组间比较采用χ^(2)检验。等级资料比较采用非参数检验。单因素分析根据资料类型选择对应的统计学方法。多因素分析以患者参与减重代谢手术决策意愿(被动决策型=1, 共享决策型=2, 主动决策型=3)为因变量, 纳入单因素分析中具有统计学意义的变量为自变量进行无序多分类Logistic回归分析。结果 (1)问卷调查结果。共发放和回收问卷568份, 剔除不合格问卷48份, 回收有效问卷520份。520例完成问卷调查患者中, 参与减重代谢手术决策类型为被动决策型231例, 共享决策型140例, 主动决策型149例。(2)肥胖症患者参与减重代谢手术决策类型的影响因素。多因素分析结果显示:以共享决策型为参照, 合并症数目(0比≥4个、1~3个比≥4个), 医疗付费方式(医疗保险比自费), 疾病了解程度(很不了解比一般了解、不大了解比一般了解), 知晓至接受手术间隔时间(1~3个月比>6个月)是影响被动决策型患者参与减重代谢外科手术决策意愿的独立因素(比值比=3.520、2.457, 2.255, 3.147、1.920, 1.854, 95%可信区间为1.552~7.984、1.215~4.968, 1.335~3.809, 1.865~5.311、1.025~3.596, 1.065~3.230, P<0.05);体质量指数(28.0~31.9 kg/m^(2)比≥37.0 kg/m^(2)、32.0~36.9 kg/m^(2)比≥37.0 kg/m^(2)), 合并症数目(0比≥4个、1~3个比≥4个), 家庭社会支持状况(较差比良好)、知晓至接受手术间隔时间(1~3个月比>6个月)是影响主动决策型患者参与减重代谢外科手术决策意愿的独立因素(比值比=2.391、2.478, 6.918、3.335, 2.974, 2.139, 95%可信区间为1.207~4.735、1.345~4.563, 2.498~19.159、1.350~8.242, 1.755~5.039, 1.156~3.957, P<0.05)。以主动决策型为参照, 体质量指数(28.0~31.9 kg/m^(2)比≥37.0 kg/m^(2)、32.0~36.9 kg/m^(2)比≥37.0 kg/m^(2)), 家庭社会支持状况(较差比良好)是影响被动决策型患者参与减重代谢外科手术决策意愿的独立因素(比值比=0.404、0.554, 0.336, 95%可信区间为0.221~0.740、0.327~0.938, 0.212~0.534, P<0.05)。(3)减重代谢手术决策辅助支持需求分析。减重代谢手术共享决策支持需求问卷调查结果显示:肥胖症患者对信息类型的需求由高到低依次为手术适应证、术后身体变化及饮食习惯调整、手术费用、手术并发症及风险、手术效果;对内容偏好的需求由高到低依次为减重代谢手术后患者经验分享、减重代谢手术前后对比照、减重代谢手术后科普、手术方式介绍、医护直播和住院环境介绍;对网络化支持途径认可度方面, 94.04%(489/520)的患者认为基于网络化途径实施共享决策支持具有可靠性。结论肥胖症患者参与减重代谢手术决策意愿较为积极, 但被动决策型占比较大。体质量指数、合并症数目、医疗付费方式、疾病了解程度、家庭社会支持状况、知晓至接受手术间隔时间是影响肥胖症患者参与减重代谢手术决策意愿的独立因素。

Objective To investigate the surgical decision-making types and its influencing factors for obesity patients participating in bariatric metabolic surgery.Methods The survey targets were patients who were scheduled to bariatric metabolic surgery in The First Affiliated Hospital of Nanjing Medical University,and the survey period was from January 1 to May 30,2024.The survey was conducted using the general demographic questionnaire,control preference scale,and shared-decision requirements questionnaire for bariatric metabolic surgery.Count data were expressed as absolute numbers and percentages,and comparison between groups was performed using the chi-square test.Comparison of ordinal data was performed using the non parametric test.Univariate analysis was performed using the corresponding statistical methods based on data types.Multivariate analysis was conducted using the willingness of patients to participate in bariatric metabolic surgery decision-making(passive decision-making=1,shared decision-making=2,active decision-making=3)as the dependent variable,and the statistically significant variables in univariate analysis were included as independent variables for disordered multi-class Logistic regression analysis.Results(1)Results of survey.A total of 568 questionnaires were distributed and collected.After removing 48 unqualified questionnaires,520 valid questionnaires were collected.Of the 520 patients who completed the questionnaire survey,there were 231 cases participating as the passive decision-making type,140 cases as shared decision-making type,and 149 as active decision-making type in bariatric metabolic surgery decision-making.(2)Influencing factors for decision-making type of obesity patients participating in bariatric metabolic surgery.Results of multivariate analysis showed that taking the shared decision-making type as a reference,the number of complication(O compared to≥4,1-3 compared to≥4),medical payment method(medical insurance compared to self-payment),degree of disease understanding(not very understanding compared to general understanding,not understanding compared to general understanding),and the interval between knowing and accep-ting surgery(1-3 months compared to>6 months)were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery deci-sions(odds ratios=3.520,2.457,2.255,3.147,1.920,1.854,95%confidence interval as 1.552-7.984,1.215-4.968,1.335-3.809,1.865-5.311,1.025-3.596,1.065-3.230,P<0.05).Body mass index(BMI)(28.0-31.9 kg/cm^(2)compared to≥37.0 kg/cm^(2),32.0-36.9 kg/cm^(2)compared to≥37.0 kg/cm"),number of complication(0 compared to≥4,1-3 compared to≥4),family and social support status(poor compared to good),and the interval between knowing and accepting surgery(1-3 months compared to>6 months)were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery decisions(odds ratios=2.391,2.478,6.918,3.335,2.974,2.139,95%confidence intervals as 1.207-4.735,1.345-4.563,2.498-19.159,1.350-8.242,1.755-5.039,1.156-3.957,P<0.05).Taking the passive decision-making type as a reference,BMI(28.0-31.9 kg/cm^(2)compared to≥37.0 kg/cm^(2),32.0-36.9 kg/cm^(2)compared to≥37.0 kg/cm)and family social support status(poor compared to good)were independent factors influencing the willingness of passive decision-making patients to participate in bariatric metabolic surgery decisions(odds ratios=0.404,0.554,0.336,95%confidence interval as 0.221-0.740,0.327-0.938,0.212-0.534,P<0.05).(3)Analysis of decision support needs for bariatric metabolic surgery.Results of shared-decision requirements questionnaire showed that the information needs of obesity patients from high to low were surgical indications,postoperative physical changes and dietary habits adjust-ments,surgical costs,surgical complications and risks,and surgical outcomes.The demand for content preference from high to low were in the form of sharing patient experience after bariatric metabolic surgery,comparing before and after bariatric metabolic surgery,popularizing science after bariatric metabolic surgery,introducing surgical methods,live streaming of medical staff,and introducing the hospital environment.In terms of recognition of networked support pathways,94.04%(489/520)of patients believed that implementing shared decision support based on networked pathways was reliable.Conclusions Obesity patients are more willing to participate in bariatric metabolic surgery decision-making.But the proportion of patients selecting passive decision-making is relatively high.BMI,number of complication,medical payment method,degree of disease understanding,family and social support status and the interval between knowing and accepting surgery are independent factors influencing the willingness of obesity patients to paticipate in bariatric metabolic surgery decisions.