Centre for Obesity, Dept. of Surgery, St. Olavs University Hospital, Norway.
Centre for Obesity, Dept. of Surgery, St. Olavs University Hospital, Norway.
Obes Res Clin Pract. 2009 Nov;3(4):193-201. doi: 10.1016/j.orcp.2009.04.004.
In the complex field of treating severe obesity, motivation is receiving increased attention. This explorative study aims to highlight what influences the preferences of severely obese patients deciding for either gastric bypass surgery or lifestyle treatment.
Patients awaiting laparoscopic gastric bypass were presented with an 18-week inpatient lifestyle programme alternative to gastric bypass. Questionnaires provided qualitative data (reasons for choosing one treatment over another) and quantitative data (mental health assessment using the Hospital Anxiety and Depression Scale). The material was analysed according to a sequential exploratory design involving thematic analysis of patients' arguments, validation using HADS, and statistical computations (hypothesis testing) with one-way ANOVA followed by Dunnett's post hoc test.
159 participants (mean BMI 47.2 kg/m(2)) returned questionnaires of which 32% wanted the lifestyle treatment alternative to surgery. Reasons for choosing the two treatments varied widely as did also the corresponding data on mental health. Two subgroups stood out with particularly high mental symptom scores, namely patients choosing surgery due to reluctance to engage in social interaction in lifestyle treatment, and patients preferring lifestyle treatment due to the fear of dying during general anaesthesia. These two subgroups showed significantly higher symptom scores than other subgroups within their therapy-of-choice group. The number of comorbid diseases was also found to impact upon motivation.
Patients carry different incentives for choosing the same type of treatment. On a subgroup level, psychopathological symptoms seem to follow motivational patterns. Analysing motivation and mental health may provide measures for identifying subgroups with various prospects for therapy outcome.
在治疗严重肥胖症的复杂领域中，动机受到越来越多的关注。本探索性研究旨在强调影响严重肥胖患者选择胃旁路手术或生活方式治疗的偏好的因素。
等待腹腔镜胃旁路手术的患者被提供了一种替代胃旁路的 18 周住院生活方式治疗方案。问卷调查提供了定性数据（选择一种治疗方案而不是另一种治疗方案的原因）和定量数据（使用医院焦虑和抑郁量表评估心理健康）。根据涉及患者论点的主题分析、使用 HADS 进行验证以及使用单向方差分析和 Dunnett 事后检验的假设检验的顺序探索性设计分析材料。
159 名参与者（平均 BMI 为 47.2kg/m²）返回了问卷，其中 32%的人希望选择生活方式治疗替代手术。选择两种治疗方法的原因差异很大，心理健康数据也不同。两个亚组的精神症状得分特别高，即由于不愿意参与生活方式治疗中的社交互动而选择手术的患者，以及由于害怕在全身麻醉期间死亡而选择生活方式治疗的患者。这两个亚组的症状得分明显高于其选择的治疗组中的其他亚组。合并症的数量也被发现会影响动机。
患者选择同类型治疗的动机各不相同。在亚组水平上，精神病理学症状似乎遵循动机模式。分析动机和心理健康状况可能会提供识别具有不同治疗结果前景的亚组的措施。
