title: Understanding the reasons for the refusal of cholecystectomy in patients with cholelithiasis: how to help them in their decision?
abstract: BACKGROUND
  Cholelithiasis is prevalent surgical disease, with approximately 60,000 admissions per year in the Unified Health System in Brazil. Is often asymptomatic or oligosymptomatic and major complications arise from the migration of calculi to low biliary tract. Despite these complications are severe and life threatening, some patients refuse surgical treatment.
  
  
  OBJECTIVE
  To understand why individuals with cholelithiasis refuse cholecystectomy before complications inherent to the presence of gallstones in the bile duct and pancreatitis occur.
  
  
  METHODS
  To investigate the universe of the justifications for refusing to submit to surgery it was performed individual interviews according to a predetermined script. In these interviews, was evaluate the knowledge of individuals about cholelithiasis and its complications and the reasons for the refusal of surgical treatment. Were interviewed 20 individuals with cholelithiasis who refused or postponed surgical treatment without a plausible reason. To these interviews, was applied the technique of thematic analysis (Minayo, 2006).
  
  
  RESULTS
  The majority of respondents had good knowledge of their disease and its possible complications, were well oriented and had surgical indications by their physicians. The refusal for surgery was justified primarily on negative experiences of themselves or family members with surgery, including anesthesia; fear of pain or losing their autonomy during surgery and postoperative period, preferring to take the risk and wait for complications to then solve them compulsorily.
  
  
  CONCLUSIONS
  The reasons for the refusal to surgical resolution of cholelithiasis were diverse, but closely related to personal (or related persons) negative surgical experiences or complex psychological problems that must be adequately addressed by the surgeon and other qualified professionals.
authors.affiliation: Faculdade de Ciências Médicas e da Saúde.
authors.forename: Adilson
authors.initials: A
authors.lastname: Peron
authors.affiliation: Faculdade de Psicologia, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
authors.forename: Ana Laura
authors.initials: AL
authors.lastname: Schliemann
authors.affiliation: Faculdade de Ciências Médicas e da Saúde.
authors.forename: Fernando Antonio de
authors.initials: FA
authors.lastname: Almeida
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D016312:Treatment Refusal; D055815:Young Adult