Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada.
Faculty of Engineering and Applied Science, University of Toronto, Toronto, M5S 1A4, Canada.
Obes Surg. 2017 Jan;27(1):102-109. doi: 10.1007/s11695-016-2250-9.
Bariatric surgery orientation sessions are often the first point of contact and a recommended component of pre-bariatric surgery assessment. Self-removal rates after bariatric program orientation are as high as 25 % despite the proven efficacy of this procedure. The objective of this study was to identify factors contributing to patient self-removal after orientation using a mixed method approach.
Patients who attended the Toronto Western Hospital Bariatric Surgery Program orientation between 2012 and 2013 and then self-removed from the program (N = 216) were included in the study. Subjects were interviewed via telephone using a semi-structured interview guide, generating both quantitative and qualitative data. Factors leading to discontinuation were rated on a five-point Likert scale. Qualitative data was analyzed using constant comparative methodology.
The response rate was 59 % with a 40.7 % completion rate (N = 88). Concerns about potential surgical risks and complications and the ability to adapt to changes in eating and drinking post-operatively were identified as the top two factors for patients' self-removal from the program. Thematic analysis uncovered 11 major themes related to patient self-removal. Unexpected themes include perceived personal suitability for the surgery, family impact of surgery, miscommunication with the family physician, and fears related to the orientation information.
This is one of the first studies examining barriers to bariatric surgery in the pre-operative setting and offers new insights into the reasons patients self-remove from bariatric surgery programs. This study may inform bariatric orientation program changes resulting in improved access to this effective surgical intervention.
减重手术介绍会通常是接触患者和推荐进行减重手术评估的第一步。尽管该手术程序已被证明有效，但仍有高达 25%的患者在参加减重计划介绍会后自行退出。本研究的目的是采用混合方法来确定导致患者在介绍会后自行退出的因素。
本研究纳入了 2012 年至 2013 年间参加多伦多西部医院减重手术计划介绍会但随后自行退出该计划的患者（N=216）。研究对象通过电话使用半结构化访谈指南进行访谈，产生了定量和定性数据。通过五点 Likert 量表对导致患者退出的因素进行评分。使用恒定性比较方法对定性数据进行分析。
回复率为 59%，完成率为 40.7%（N=88）。对手术潜在风险和并发症的担忧以及术后适应饮食和饮水变化的能力被确定为患者自行退出该计划的前两个主要因素。主题分析揭示了与患者自行退出该计划相关的 11 个主要主题。意外的主题包括对手术的个人适宜性的看法、手术对家庭的影响、与家庭医生的沟通不畅以及对介绍会信息的担忧。
这是研究术前减重手术障碍的首批研究之一，为患者自行退出减重手术计划的原因提供了新的见解。本研究可能为减重手术介绍计划的改变提供信息，从而改善对这一有效手术干预措施的获取。
