title: In the queue for total joint replacement: patients' perspectives on waiting times. Ontario Hip and Knee Replacement Project Team.
abstract: 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.
authors.affiliation: Clinical Epidemiology Unit, Sunnybrook Health Science Centre, North York, Ontario, Canada.
authors.forename: H A
authors.initials: HA
authors.lastname: Llewellyn-Thomas
authors.forename: R
authors.initials: R
authors.lastname: Arshinoff
authors.forename: M
authors.initials: M
authors.lastname: Bell
authors.forename: J I
authors.initials: JI
authors.lastname: Williams
authors.forename: C D
authors.initials: CD
authors.lastname: Naylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000401:mortality / Q000523:psychology*; D001294:Attitude to Health; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010003:Osteoarthritis / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D018579:Patient Selection; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014850:Waiting Lists