الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Bariatric surgery shared decision-making, which integrates patient values and preferences with current medical knowledge to aid in the challenging selection process for bariatric surgery and help the public system allocate resources, may be beneficial to both patients and practitioners.If surgeons were asked to assume the role of their patients, their preferences would be comparable to those of the patients, with some exceptions, notably those relating to sensitivity to the risk of consequences and out-of- pocket expenses. Most of the research on bariatric surgery patients studied the public knowledge, perceptions, and acceptability of different types and features related to the surgery.We found few studies that focused on the preferences of patient populations weather suffering from certain medical conditions like diabetes or other medical conditions beside obesity or focusing on certain patient category like those comparing males and females’ preferences.
This study aims to reveal the full picture and the whole case scenario of the Egyptian obese patient’s preference for bariatric surgery using a novel technique adaptive choice based conjoint analysis (ACBC).6.1.2. Methods Study design: A cross-sectional survey was conducted during which the adaptive choice based tasks were presented to the patients.Setting: The bariatric surgery clinic of the Medical Research Institute, Alexandria University.Population: Patients seeking weight loss at the bariatric surgery clinic of the Medical Research Institute, Alexandria University.Sample size: The minimum required sample size is 250 respondents. It was calculated and tested using Sawtooth software which is computer software specialized in conjoint analysis and provides tools that help in creating, fielding, and analyzing market research surveys.Adaptive choice based conjoint analysis survey which created using sawtooth software was consisted of four parts: A sociodemographic survey collected the participants’ age, sex, marital status, educational level, employment status, medical conditions, current BMI, and income. ACBC tasks that changed based on the response given by the participant explored their perceptions the importance of different features in bariatric surgery in the decision making process and explore the trade off process that occur during their choices, which consist of three stages:Summary, Recommendation and Conclusion 46 Build your own (BYO) configuration section, where only one level is indicated by patients as the most preferred one per each attribute.Screening section, which used an alternative specific design that generated distinct sets of attributes and identify must have and unacceptable options for each alternative based on the artificial intelligence technology.Choice tasks section which utilize the partial specific design that focused on a limited number of traits beside that the number of choice tasks varies between respondents based on the respondents’ determination and selection of levels of particular attributes until determining the most preferred choice set based on a trade off process in different generated scenarios.6.1.3 Statistical Analyses:Adaptive Choice based Conjoint Analysis: Sawtooth software was used to determine the relative importance for each attribute as well as the part worth utility for their levels using a hierarchical Bayes (HB) analysis model.Clustering analyses: K-mean clustering analysis based on utility values of levels and demographic criteria which divided the data into two groups (Risk averse VS Risk taker). Comparison analysis between the clusters (Risk averse VS Risk taker): Comparative analysis based on both sociodemographic characteristics as well as the values of attribute importance and level’s utility values.6.1.4 Results During six months, a total of 299 obese were surveyed. The majority of patients were between 30 and < 45 years old (56.9%), 75.6% were female, and 75.6% had at least a university education. One third (34.8%) were full-time employees. Approximately, half were just meeting daily expenses (53.2%), 84% were non – smoker, 65.6% were married, and BMIs were between 30-40 in 52.2%. The most frequent health condition was arthritis (21%).For the total sample, the surgical profile has a higher preference if it decreases the hunger sensation along with eating a small portion of normal food and buy vitamins not reversible with 10 years availability, resolve all medical conditions with neither risk of complication nor adverse effects and achieve the highest percentage of excess weight loss without any regain (Lose 80%, regain 0%) with reasonable cost.Attribute’s importance were in the following order: ” number of kgs lost in the first year and regained in the second year” (14.67%), ”risk of complication” (13.74%), ”Adverse effects” (11.32%”), ”Surgery availability” (11.16%), ”Surgery magnitude” (10.60%), ”Diet changes” (10.41%), ”Surgery mechanism” (10.24%), ”improvement of health condition” (9.33%), and ”out of pocket cost” (8.52%).K-Means analysis using a novel meta-clustering algorithm and based on utility values of levels and demographic criteria revealed two primary clusters with reproducibility 98.7%, where risk taker cluster holding the most of analysed cases (56%) compared to risk averse cluster (44%). Regarding demographic characteristics, we found no significant difference between risk averse & risk taker except for education level. Those whose ages between 45 and 60 years old were more likely to be risk taker compared to ages 18 - < 30 years old (OR= 2.21, CI (1.03, 4.75)). Also, those whose education was less than university were more likely to be risk taker compared to university education or higher (OR= 1.87, CI (1.07,3.25)).Summary, Recommendation and Conclusion 47 For risk takers attributes’ importance were in the following order, ”excess weight loss” (16.13), ”surgery availability” (12.65), ”Diet change” (11.95), ”surgery magnitude” (11.13), ”surgery mechanism of action” (10.21), ”adverse effect” (10.03), ”out of pocket cost” (9.67), ”Risk of complication” (9.49), and ”Improvement of health condition” (8.73).Whereas for risk averse attributes’ importance were in the following order, ”Risk of complication” (19.12), ”adverse effect” (12.95), ”Excess weight loss” (12.81), ”Surgery mechanism of action” (10.28), ”Improvement of health condition” (10.09), ”Surgery magnitude” (9.93), ”surgery availability ” (9.29), ”Diet change” (8.47), and ”out of pocket cost” (7.05).Risk taker preferred a surgical profile that restricts food with decreasing hunger allowing eating small portions from mammal food with a vitamin supplement, irreversible with 2 weeks recovery, available since 10 years, causing 80% weight loss without any regain, improving existing medical conditions, with 5% risk of complications, nausea vomiting reflex stomach pain as adverse effects and with medium cost.Risk averse preferred a surgical profile similar to risk takers except for complications, adverse effects, and cost. They preferred a surgical profile free from complications as well as adverse effects and with low cost.6.1.5 Conclusion The most preferable bariatric surgical profile for obese patients was that which decreases the hunger sensation along with eating small portions of normal food and buy vitamins, resolve all medical conditions with neither risk of complication nor adverse effects, and achieve the highest percentage of excess weight without any regain (Lose 80%, regain 0%) and with reasonable cost.After conducting cluster analysis our sample was divided into risk taker group which focused on weight loss regardless of the risk of complications they may face in the surgery. On the other hand, the risk averse group was more considering the risk of complication as a critical point when choosing the surgical profile. Out of pocket cost was more important for the risk taker group.6.1.6 Recommendations Assessing and integrating patient preference with the surgeon’s experience to make the ideal decision.Keeping a database for patients’ preferences and utilizing this information along with the patient profile to decide whether or not performing the bariatric surgery.Using the adaptive choice based conjoint analysis experiment as a valuable tool in identifying patients’ preferences studies regarding different sectors and services in health care. Emphasizing positive weight loss impact and cost-effectiveness for risk takers to help them in making informed decisions that align with their priorities .Focusing on safety, durability, and long-term health benefits for the risk-averse group, addressing potential complications with reassurance to guide them in the decision making process.