Centre for Studies in Primary Care, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Clin Obes. 2023 Feb;13(1):e12558. doi: 10.1111/cob.12558. Epub 2022 Oct 7.
The objective of the study was to explore the experience of patients who self-withdrew from their scheduled bariatric surgery (BS) after completing the lengthy multidisciplinary assessment and optimization process, and to examine how these withdrawals affect healthcare providers (HCPs) in a Bariatric Centre of Excellence (BCoE). Interviews were conducted with patients who self-withdrew, within 1 month, from scheduled BS. Additionally, a focus group with HCPs from the same BCoE was completed. The data were analysed using an inductive, emergent thematic approach with open coding in NVivo 12, with comparative analysis to identify common themes between groups. Eleven patients and 14 HCPs participated. HCPs identified several behavioural and logistical red flags among patients who self-withdrew from scheduled BS. Patients and HCPs felt the decision was appropriate, owing to a patient's lack of mental preparedness for change, social supports, or fears of postoperative complications. HCPs reported frustration and described negative impacts on clinic efficiency. Additional mental health resources for patients contemplating self-withdrawal, such as peer support, were suggested. In conclusion, a patient's decision to self-withdraw from a scheduled BS is often sudden, definite, and associated with anxiety, fear of surgical risks and post-operative complications. Additional mental health resources at a BCoE may be beneficial to support patients at risk of self-withdrawal from scheduled BS.
本研究旨在探讨已完成冗长的多学科评估和优化流程但最终自行退出择期减重手术（BS）患者的体验，并分析这些退出行为对减重卓越中心（BCoE）内的医疗保健提供者（HCP）有何影响。我们对在 1 个月内自行退出择期 BS 的患者进行了访谈，此外，还与来自同一 BCoE 的 HCP 进行了焦点小组讨论。采用 NVivo 12 软件中的开放式编码对数据进行了归纳性、新兴主题分析，并进行了对比分析以确定组间的共同主题。共有 11 名患者和 14 名 HCP 参与。HCP 确定了一些行为和后勤方面的红旗标志，这些标志与自行退出择期 BS 的患者有关。患者和 HCP 认为该决定是恰当的，原因是患者缺乏改变的心理准备、社会支持或对术后并发症的恐惧。HCP 报告感到沮丧，并描述了对诊所效率的负面影响。建议为考虑自行退出的患者提供额外的心理健康资源，例如同伴支持。总之，患者自行退出择期 BS 的决定通常是突然的、明确的，并伴有焦虑、对手术风险和术后并发症的恐惧。BCoE 额外的心理健康资源可能有助于支持有自行退出择期 BS 风险的患者。
