Competencies and skills to enable effective care of severely obese patients undergoing bariatric surgery across a multi-disciplinary healthcare perspective: a systematic review.

摘要

Executive summaryBackgroundThe incidence of severe and complex obesity with co-morbidity and high risk of mortality is increasing globally. Bariatric surgery is the only intervention leading to sustained weight reduction, and the number of procedures carried out is increasing. There is variability across the UK in the provision of bariatric services and in perceptions of optimum care. A key factor believed to be integral is a multidisciplinary team (MDT) specifically skilled for the speciality. However, there is a lack of clarity on the competencies required for specific roles within the bariatric surgery team.ObjectivesThis review synthesized literature on perceived competencies and skills required to provide safe, meaningful and appropriate care for severely obese patients undergoing bariatric surgery.Inclusion criteriaTypes of participantsThe review initially concentrated on four key roles: surgeon, nurse, dietitian, and psychologist. Where available, literature pertaining to other practitioners such as physiotherapists and anesthetists was included.Phenomenon of interestCompetencies and skills required by MDT members to provide care for severely obese patients undergoing bariatric surgery.Types of studiesThe review included qualitative research studies, policy documents, standards for clinical care, guidelines, narratives, opinion pieces and discussion papers.Search strategyA search strategy was designed to access both published and unpublished materials in the following databases: CINAHL, Medline, ERIC, PsycINFO, IngentaConnect, The Knowledge Network, and Web of Knowledge. Grey literature was searched in British Library Ethos and National Institute for Social Care & Health Research (NISCHR).Methodological qualityPapers selected were independently appraised for quality by two reviewers using the Joanna Briggs Institute Narrative, Opinion and Text Assessment and Review Instrument (JBI-NOTARI).Data collectionData were extracted using JBI-NOTARI data extraction tool. Extracted data included participant information, logic of argument, and author conclusions.ResultsThirty-six papers were screened, and 13 were excluded because they lacked information about competencies. Twenty-three papers met the inclusion criteria and proceeded to quality assessment.The literature was poorly developed, consisting of text and opinion type articles. Papers were pooled using JBI-NOTARI, involving the synthesis of publication conclusions into categories, which were then amalgamated in meta-syntheses. Three overall synthesised findings emerged:Safe, meaningful and appropriate care of severely obese patients undergoing bariatric surgery may be delivered if staff in each role achieve a minimum set of competencies.Safe, effective and meaningful care for bariatric surgery patients may require a minimum set of competencies for managing a bariatric surgery unit and the MDT.To achieve the competencies for safe, effective and meaningful care for bariatric surgery patients, certain approaches to education may be developed.ConclusionsReviewed articles gave some broad indication of areas in which to develop competencies. Consensus between practitioners is required to take forward strategies for competency development.Implications for practiceSensitive care, preoperative psychological assessment, postoperative care, including identification of complications and team management, are areas in which competencies in the MDT should be developed.Implications for researchMixed methods studies to establish best practice and required competencies. Evaluative component in all educational interventions. Comparison studies of methods of delivery of competency based education, and measurement of effectiveness.