Bariatric surgery services are in Germany are diverse and varied for both pre- and post-operative care, according to a small study by researchers from the Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Witten, Germany. They conclude that although this was a small study the heterogeneous healthcare delivery and information provision on patients’ information needs for bariatric surgery needs to be investigated in patients and other healthcare professionals. The findings were featured in the paper, ‘Healthcare delivery and information provision in bariatric surgery in Germany: qualitative interviews with bariatric surgeons’, published in BMC Health Services Research.
The authors noted that bariatric surgery involves a multi-disciplinary approach including bariatric surgeons, nutritionists, clinicians, endocrinologists, psychologists etc in outpatient settings. It is therefore essential that trustworthy health information is given to patients so they can understand their diagnosis, treatment decisions and possible prognosis. Therefore, the researchers undertook this study to outline the delivery of healthcare regarding bariatric surgery from the perspective of bariatric surgeons in Germany, and describe the information provision within healthcare delivery. This study is part of a larger research project to identify the information needs of patients undergoing surgery including surgeons, patients and nutritionists.
The researchers conducted 15 semi-structured telephone interviews that consisted of four sections (information about the clinic/surgeon and surgical procedures, preoperative procedure, postoperative procedure, information needs). Bariatric surgeons from 68 clinics were contacted through the German Society for General and Visceral Surgery, and the overall response rate of the clinics was 20.6% (14/68). The interview consisted of four main sections (general information about the clinic/surgeon and surgical procedures, preoperative procedure, postoperative procedure, information needs), and included:
demographic information of the surgeon and general information on the clinic
the content of the first appointment with a patient (patient-doctor appointments) and the information given in these appointments
preoperative organisational requirements and standards a patient had to do, including weight management program (appointments with nutritionists/surgeons, group meetings, dietary/exercise programmes etc) and the most common questions patients had prior to surgery
postoperative process at the clinic and list the most common problems and questions of postoperative patients, information provision, information needs and future approaches for information provision.
In total, nine surgeons (male (67%) and six were female (33%)), between April 2018 and February 2019 were included in the study, who worked in clinics that had a minimum of two and a maximum of five bariatric surgeons and performed 70 to 500 bariatric surgeries each year. The clinics prioritised performing either sleeve gastrectomy or gastric bypass (mostly Roux-en-Y bypass) or both procedures equally.
The researchers found that there were two different pre-operative starting points for patients: clinics for bariatric surgeons and nutritionists. It is mandatory for all patients to go to a clinic for BS and speak to a bariatric surgeon and a nutritionist based on weight management program prior to surgery in order to obtain cost coverage from their health insurance fund. The appointments with the surgeon were individual patient-doctor conversations, while appointments with the nutritionist could be either individual (within the clinic or external) or in group meetings with other patients.
If the nutritionist in an outpatient settings, there was little to no information sharing regarding each patient between the surgeon and the nutritionist. Consequently, neither of them was aware of the information already given to the patients by the other. In addition, they also found that it was rare for a surgeon to join nutritional group meetings.
Most clinics (n=13) were directly cross-linked to a support group and often provided premises for support group meetings. Some surgeons visited the support group meetings periodically to answer questions. If asked, most of the surgeons outlined the important role of support groups while indicating that the information given by the support group is based on experience and not necessarily evidence.
Most clinics used individual appointments with the surgeon and one additional approach, and some used several approaches (eg, flyer, homepages, social media). Seven surgeons had informational group sessions with either a surgeon or a nutritionist.
Most surgeons declared that they informed patients about costs for supplementation and approximately half of the surgeons provided additional information about the cost of plastic surgery or gave that information on demand, the other half did not comment on this.
The vast majority of surgeons reported that there are many questions before surgery even though they indicated that many patients are well informed about the different procedures. There seem to be three categories of questions:
general questions about the different procedures, pros, and cons as well as the risks of each procedure, weight loss, supplementation, and complications, regardless of the amount of information already given to the patients in that matter
specific questions about medical issues such as medication use, the chance of becoming pregnant after surgery, or present comorbidities; and
questions regarding everyday life, such as duration of sick leave, ability to work out after surgery, or potential plastic surgery.
In most instances, postoperative care mostly included 1–2 appointments with the surgeon. Some surgeons gave a timeframe of 15–20 min, and some said that the duration depends on the patient’s issues. Usually, patients present 1–3 times in the first year after the procedure and annually thereafter.
Postoperative psychotherapy is not offered in all but one of the clinics, mostly because of the lack of financial support by health insurance funds. However, some clinics cooperated with internal or external psychotherapists in some form of on-demand offer. There were no postoperative information provision approaches other than the individual appointments with the surgeons. However, some clinics were linked to support groups that could be joined after surgery.
Postoperative questions related directly to the new life situation and adapting to these. Most questions centred on nutritional problems, medication use or weight loss, especially in comparison to other bariatric patients.
Finally, the surgeons were asked to express their opinion of the greatest challenge in information provision in the context of BS. There were three categories of given answers:
the internet and its ambivalent influence on the given information
there seems to be an overload of information
the individuality of each patient regarding their level of education, compliance, health literacy, or even personality, which requires individual, customised information provision.
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