Self‐withdrawal from scheduled bariatric surgery: Qualitative study exploring patient and healthcare provider perspectives

Abstract

Summary 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.

Factors associated with progression or non‐progression to bariatric surgery in adults: A systematic review

“…Binge eating was also found to predict non‐progression but only for women 56 . Qualitative findings highlighted concerns about adapting to and sustaining post‐surgery dietary changes as patient‐identified barriers to progression 44,53,59,78 …”

“…Qualitative research also revealed concerns about the “emotional impacts” of excess weight, with participants pursuing surgery to remedy negative feelings about themselves and increase self‐esteem 44,72 . However, some patients described mental health issues, such as anxiety, compelling them to withdraw from surgery, with associated thoughts of not being “ready” for the process 53 …”

“…56 Qualitative findings highlighted concerns about adapting to and sustaining post-surgery dietary changes as patientidentified barriers to progression. 44,53,59,78 3.12 | Substance use and smoking…”

“…Additional studies mentioned fears about mortality during surgery, as well as concerns about postsurgery complications and challenges (e.g., weight regain, loose skin, relying on supplements and liquids, dumping syndrome, metabolic changes, and delayed pregnancy), as barriers to surgery. 29,44,53,59 3.16 | Choice of surgery…”

“…44,72 However, some patients described mental health issues, such as anxiety, compelling them to withdraw from surgery, with associated thoughts of not being "ready" for the process. 53…”