A mixed methods feasibility and pilot study for a controlled clinical trial to assess the impact of pre operative psychosocial education on Health Related Quality of Life following bariatric surgery

Obesity is an increasing problem, with bariatric surgery as one of the main treatment modalities. Patients undergoing surgical intervention appear to receive little psychosocial education and support; support that has the potential to positively affect their health related quality of life (HRQOL) post operatively. No standardised pre operative education for bariatric surgery patients exists within the United Kingdom. Additionally, no research explores the impact of psychosocial education on post-operative HRQOL. Given the impact that obesity and bariatric surgery have on HRQOL, alongside the high incidence of psychological disorders in this population, there is need for research and service improvement in this area. This research study uses a sequential mixed methods approach to develop and test a pre operative group psychosocial educational course, in a controlled clinical trial. The initial feasibility stage highlighted methodological flaws. These were considered and revised before proceeding to a pilot study. Qualitative research was used to explore the perceptions and experiences of pre operative education in post-bariatric surgery candidates. Three main themes were identified relating to changes in their post-operative HRQOL, and surgical preparation: realities of surgery, psychosocial support, and tips and tricks. Key findings highlighted the importance of measuring HRQOL in terms of physical, mental and social health from the patient’s perspective, and how post operatively, psychosocial health is important. Guilt and shame around accessing bariatric surgery was also raised as an issue, particularly associated with guilt of spending NHS money on obesity treatment. Findings from the qualitative work informed the development of the educational course. A final pilot study was conducted using the improved educational course and methodological revisions highlighted from the feasibility study. The results of the pilot suggest that a larger-scale clinical trial to investigate the impact of pre operative psychosocial education on HRQOL using the methods and intervention testing in this study is warranted