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Patients’ perceptions

Perceptions of access and waiting for surgery

three important areas of perceived inequity related to waiting for bariatric surgery: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritisation.

Patients’ perceptions of accessing and waiting for bariatric surgery are shaped by perceived and experienced inequities within the healthcare system, according to a research paper titled 'Patients' perceptions of waiting for bariatric surgery: a qualitative study', published in the International Journal for Equity in Health. The paper calls for a system to address these socioeconomic, regional and waitlist inequities. Specifically, it states that ‘equitable access to treatment should be a health system priority’ and that ‘supports and resources are required to ensure the waiting experience is as positive as possible’.

Researchers from Memorial University, Newfoundland and Labrador, Canada, wanted to explore patients’ perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioural impact of waiting for treatment and identify healthcare provider and health system supportive measures that could potentially improve the waiting experience.

The primary objective was to develop an understanding of the pre-surgical experience of patients that choose to undergo a surgical weight loss intervention for the management of morbid/clinical obesity after being placed on a waitlist for bariatric surgery. The meaning of bariatric surgery and the psychosocial impact of waiting for this form of treatment for individuals must be understood if multidisciplinary bariatric clinical team providers are to act as facilitators in promoting satisfaction with care and quality care outcomes.

“In a publicly funded healthcare system that promotes universal care, this research is highly relevant for policy makers who want to ensure that patients have equal access to treatment based on need,” they write. “In this paper we focus on patients’ experiences while waiting, particularly the emotional consequences of waiting, and the insights that these experiences bring to a discussion of equity, including socioeconomic, regional, and waitlist prioritization inequities. We include participants’ recommendations on how the waiting experience can be made more positive.”

Study

Twenty-one women and six men engaged in in-depth interviews between June 2011 and April 2012. The data were subjected to re-analysis to identify perceived healthcare provider and health system barriers to accessing bariatric surgery.

The age of participants ranged from 26 to 64 years, with an average age of 45.3 years. Six participants (22%) had a high school education or less, 15 (56%) had some post-secondary education and six (22%) had a university degree. The majority of participants were Caucasian (26, or 96%, while one identified as aboriginal), married or living with a common-law partner (18, or 66%), had children (21, or 78%), and were working full-time (16, or 59%). Approximately 85% of the sample reported three or more co-morbid conditions.

BMI data were not collected during the interview since all participants met the Canadian consensus guidelines for eligibility for criteria for bariatric surgery, were approved for bariatric surgery by the bariatric surgeon, and at the time of the initial interview, were waiting for bariatric surgery. Participants’ self-identified waiting periods at the time of the interview varied widely, with one third waiting for less than six months, and half waiting for more than five years.

Outcomes

The researchers reported that the participants highlighted three important areas of perceived inequity related to waiting for bariatric surgery: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritisation.

Health system level factors including the lack of availability of bariatric surgical services and individual level factors related to the financial burden associated with accessibility of the existing service were viewed as obstacles or barriers.

They also said that the longer the waiting period was for surgery, the more difficult it was for participants to stay motivated and engaged in maintaining their current health as they prepared for surgery

The researchers also comment on the regional and provincial variations in capacity for bariatric surgery. It is estimated that demand for bariatric surgery exceeds potential capacity by over 600-fold. In addition, they note that six of the thirteen provinces and territories have no bariatric surgery programme, so patients from these regions must travel to other provinces for bariatric surgery. However, many of these provinces do not accept non-residents due to the length of their wait lists.

Conclusion

“This study also brings attention to the need for a concerted effort to address the growing dissatisfaction of patients accessing bariatric surgery and the perceived unacceptable wait times that arise once the patient is deemed eligible to undergo the surgery,” the authors conclude. “Recommendations on how to improve the waiting experience included periodic updates from the surgeon’s office about their position on the wait list; a counsellor who specialises in helping people going through this surgery, dietician support and further information on what to expect after surgery, among others.”

To access the article, please click here

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