title: Factors Leading to Self-Removal from the Bariatric Surgery Program After Attending the Orientation Session.
abstract: 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.
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada.
authors.forename: Kai
authors.initials: K
authors.lastname: Yang
authors.affiliation: Faculty of Engineering and Applied Science, University of Toronto, Toronto, M5S 1A4, Canada.
authors.forename: Binghao
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Bariatric Surgery Program, Department of General Surgery, Toronto Western Hospital, Toronto, M5T 2S8, Canada.
authors.forename: Patti
authors.initials: P
authors.lastname: Kastanias
authors.affiliation: Bariatric Surgery Program, Department of General Surgery, Toronto Western Hospital, Toronto, M5T 2S8, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Bariatric Surgery Program, Department of General Surgery, Toronto Western Hospital, Toronto, M5T 2S8, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Okraniec
authors.affiliation: Centre for Mental Health, Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada. sanjeev.sockalingam@uhn.ca.|Toronto General Hospital, 200 Elizabeth St-8EN228, Toronto, ON, M5G 2C4, Canada. sanjeev.sockalingam@uhn.ca.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000193:education / Q000379:methods / Q000523:psychology; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery*; D010353:Patient Education as Topic; D010465:Perception; D011184:Postoperative Period; D012307:Risk Factors; D012649:Self Concept; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data
keywords: Bariatric surgery; Orientation; Self-removal