In the queue for total joint replacement: patients' perspectives on waiting times
Article first published online: 31 OCT 2003
Journal of Evaluation in Clinical Practice
Volume 4, Issue 1, pages 63–74, February 1998
How to Cite
Llewellyn-Thomas, H. A., Arshinoff, R., Bell, M., Williams, J. I. and Naylor, C. D. (1998), In the queue for total joint replacement: patients' perspectives on waiting times. Journal of Evaluation in Clinical Practice, 4: 63–74. doi: 10.1046/j.1365-2753.1998.t01-1-00006.x
- Issue published online: 31 OCT 2003
- Article first published online: 31 OCT 2003
- Cited By
- time preferences;
- total joint replacement;
We assessed patients on the waiting lists of a purposive sample of orthopaedic surgeons in Ontario, Canada, to determine patients' attitudes towards time waiting for hip or knee replacement. We focused on 148 patients who did not have a definite operative date, obtaining complete information on 124 (84%). Symptom severity was assessed with the Western Ontario/McMaster Osteoarthritis Index and a disease-specific standard gamble was used to elicit patients' overall utility for their arthritic state. Next, in a trade-off task, patients considered a hypothetical choice between a 1-month wait for a surgeon who could provide a 2% risk of post-operative mortality, or a 6-month wait for joint replacement with a 1% risk of post-operative mortality. Waiting times were then shifted systematically until the patient abandoned his/her initial choice, generating a conditional maximal acceptable wait time.
Patients were divided in their attitudes, with 57% initially choosing a 6-month wait with a 1% mortality risk. The overall distribution of conditional maximum acceptable wait time scores ranged from 1 to 26 months, with a median of 7 months. Utility values were independently but weakly associated with patients' tolerance of waiting times (adjusted R-square = 0.059, P= 0.004). After splitting the sample along the median into subgroups with a relatively ‘low’ and ‘high’ tolerance for waiting, the subgroup with the apparently lower tolerance for waiting reported lower utility scores (z= 2.951; P= 0.004) and shorter times since their surgeon first advised them of the need for surgery (z= 3.014; P= 0.003).
These results suggest that, in the establishment and monitoring of a queue management system for quality-of-life-enhancing surgery, patients' own perceptions of their overall symptomatic burden and ability to tolerate delayed relief should be considered along with information derived from clinical judgements and pre-weighted health status instruments.