Recommendations from Two Citizens’ Juries on the Surgical Management of Obesity
It is important that guidelines and criteria used to prioritise access to bariatric surgery are informed by the values of the tax-paying public in combination with the expertise of healthcare professionals. Citizens’ juries are increasingly used around the world to engage the public in healthcare decision-making. This study investigated citizens’ juries about prioritising patient access to bariatric surgery in two Australian cities.
The objective of this study is to examine public priorities for government expenditure on the surgical management of obesity developed through either a one or three-day citizen jury.
A three-day jury was held in Brisbane and a one-day jury in Adelaide. Jurors were selected in Brisbane (n = 18) and in Adelaide (n = 12) according to pre-specified criteria. Expert witnesses from various medical disciplines and consumers were cross-examined by jurors.
The verdicts of the juries were similar in that both juries agreed bariatric surgery was an important option in the management of obesity and related comorbidities. Recommendations about who should receive treatment differed slightly across the juries. Both juries rejected the use of age as a rationing tool, but managed their objections in different ways. Participants’ experiences of the jury process were positive, but our observations suggested that many variables may influence the nature of the final verdict.
Citizen’s juries, even when shorter in duration, can be an effective tool to guide the development of health policy and priorities. However, our study has identified a range of variables that should be considered when designing and running a jury and when interpreting the verdict.
KeywordsCitizen council Decision-making Public engagement Obesity management
The authors gratefully acknowledge the valuable input from all the expert witnesses, stakeholders, the jurors and the input from Debbie Cowan of Queensland Health for her work in facilitating engagement with Queensland Health. We also thank Kylie Rixon, Cassandra Ranatunga and the expert facilitators—Mr. Max Hardy of Max Hardy Consulting, Melbourne Australia and Ms. Danielle Annells of Danielle Annells Consulting Sydney Australia.
Compliance with Ethical Standards
This project was approved by the Griffith University Human Research Ethics Committee (Ref: MED/09/13/HREC) and the Metro South Hospital and Health Service Research Ethics Committee (Ref: HREC/12/QPAH/330). Informed consent was obtained from all individual participants included in the study.
Conflicts of Interest
The authors declare that they have no conflict of interest.
- 3.O’Brien P, MacDonald L, Anderson M, et al. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg. 2013;257(1):87–94. https://doi.org/10.1097/SLA.0b013e31827b6c02.CrossRefPubMedGoogle Scholar
- 4.National Health and Research Council. Summary guide for the management of overweight and obesity in primary care. Canberra; 2013.Google Scholar
- 6.Picot J, Jones J, Colquitt J, Gospodarevskaya E, Loveman E, Baxter L, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technology Assesment 2009;13(41).Google Scholar
- 7.National Institute for Health and Clinical Excellence. Obesity: identification, assessment and management. Clinical guideline. London: National Institute for Health and Clinical Excellence; 2014.Google Scholar
- 8.Australian Institute of Health and Welfare. Weight loss surgery in Australia. Canberra Australian Institute of Health and Welfare; 2010. Report No.: Cat. no. HSE 91.Google Scholar
- 11.National Health and Research Council. Management of overweight and obesity in adults, adolescents and children. Clinical practice guidelines for primary care health professionals. Public consultation draft. Canberra; 2012.Google Scholar
- 12.National Institute for Health and Clinical Excellence. Bariatric surgical service for the treatment of people with severe obesity. Commissioning guide. Implementing NICE guidance. London: National Institute for Health and Clinical Excellence, 2007.Google Scholar
- 13.National Institutes of Health. Gastrointestinal surgery for severe obesity: National Institutes of Health consensus development conference statement. Am J Clin Nutr. 1992;22(2):615S–9S.Google Scholar
- 14.Davies C, Wetherell M, Barnett E, et al. Opening the box: evaluating the citizens council of NICE. Milton-Keynes: The Open University; 2005.Google Scholar
- 17.National institute for Health and Clinical Excellence. Appraising life-extending, end of life treatments London: NICE; 2009 [17 Dec 2017]. Available from: https://www.nice.org.uk/guidance/gid-tag387/resources/appraising-life-extending-end-of-life-treatments-paper2.
- 18.Commonwealth of Australia 2016. Progress in Australian regions yearbook. Canberra, 2016.Google Scholar
- 19.Private Health Insurance Administration Council. Membership and Coverage Sydney, NSW: Australian Prudential Regulation Authority, 2015 [Available from: www.apra.gov.au/PHI/PHIAC-Archive/Pages/PHIAC-Archive-Membership-and-Coverage.aspx.
- 21.Scuffham P, Moretto N, Krinks R, et al. Engaging the public in healthcare decision-making: results from a citizen’s jury on emergency care services. Emerg Med J. 2016;0:1–7.Google Scholar
- 23.Australian Institute of Health and Welfare. Health expenditure Australia 2015–16. Canberra: AIHW; 2017.Google Scholar
- 25.Amelung N. The emergence of citizen panels as a de facto standard. Quaderni. 2012;79:13–28. https://doi.org/10.4000/quaderni.616
- 26.Krinks R, Kendall E, Whitty JA, Scuffham PA. Do consumer voices in health‐care citizens’ juries matter? Health Expectations. 2016;19(5):1015–22Google Scholar