title: Patients' perceptions of waiting for bariatric surgery: a qualitative study.
abstract: BACKGROUND
  In Canada waiting lists for bariatric surgery are common, with wait times on average > 5 years. The meaning of waiting for bariatric surgery from the patients' perspective must be understood if health care providers are to act as facilitators in promoting satisfaction with care and quality care outcomes. The aims of this study were to explore patients' perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioral impact of waiting for treatment and identify health care provider and health system supportive measures that could potentially improve the waiting experience.
  
  
  METHODS
  Twenty-one women and six men engaged in in-depth interviews that were digitally recorded, transcribed verbatim and analysed using a grounded theory approach to data collection and analysis between June 2011 and April 2012. The data were subjected to re-analysis to identify perceived health care provider and health system barriers to accessing bariatric surgery.
  
  
  RESULTS
  Thematic analysis identified inequity as a barrier to accessing bariatric surgery. Three areas of perceived inequity were identified from participants' accounts: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritization. Although excited about their acceptance as candidates for surgery, the waiting period was described as stressful, anxiety provoking, and frustrating. Anger was expressed towards the health care system for the long waiting times. Participants identified the importance of health care provider and health system supports during the waiting period. Recommendations on how to improve the waiting experience included periodic updates from the surgeon's office about their position on the wait list; a counselor who specializes in helping people going through this surgery, dietitian support and further information on what to expect after surgery, among others.
  
  
  CONCLUSIONS
  Patients' perceptions of accessing and waiting for bariatric surgery are shaped by perceived and experienced socioeconomic, regional, and waitlist prioritization inequities. A system addressing these inequities must be developed. Waiting for surgery is inherent in publicly funded health care systems; however, ensuring equitable access to treatment should be a health system priority. Supports and resources are required to ensure the waiting experience is as positive as possible.
authors.affiliation: Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St, John's, Newfoundland and Labrador, Canada. dgregory@mun.ca.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Gregory
authors.forename: Julia
authors.initials: J
authors.lastname: Temple Newhook
authors.forename: Laurie K
authors.initials: LK
authors.lastname: Twells
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000523:psychology*; D002170:Canada; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014850:Waiting Lists