title: Conceptualising time before surgery: the experience of patients waiting for hip replacement.
abstract: Interpretations of time underlie patients' experiences of illness and the way in which the National Health Service (NHS) is organised. In the NHS, achieving short waiting times for treatment is seen as important, and this is particularly evident in relation to chronic conditions where the time waiting in care from onset of symptoms to successful management can last months and years. One example of a chronic condition with high prevalence is osteoarthritis, estimated to affect 10% of people aged over 55 years in the UK. Osteoarthritis of the hip is particularly common, and treatments include exercise and medication. If these options do not provide enough relief from pain and functional difficulties, then joint replacement may be considered. With over 70,000 such operations conducted every year in England and Wales, processes relating to waiting times impact on many patients. This article explores how 24 patients with osteoarthritis experience time during the lead up to hip replacement surgery. We draw on data collected during longitudinal in-depth interviews with patients a median of 9.5 days before surgery and at two to four weeks post-operatively. Transcripts of audio-recorded interviews were imported into Atlas.ti(®) and inductive thematic analysis undertaken. Increasing pain and deterioration in function altered the experience of time during the journey towards hip replacement. Patients made essential changes to how they filled their days. They experienced lost and wasted time and faced disruption to the temporal order of their lives. A surgical date marked in the calendar became their focus. However, this date was not static, moving because of changing perceptions of duration and real-time alterations by the healthcare system. Findings highlight that patients' experience of time is complex and multi-dimensional and does not reflect the linear, monochronic conceptualisation of time embedded in the healthcare system.
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: emma.johnson@bristol.ac.uk.
authors.forename: Emma C
authors.initials: EC
authors.lastname: Johnson
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: J.Horwood@bristol.ac.uk.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Horwood
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, UK. Electronic address: R.Gooberman-Hill@bristol.ac.uk.
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology*; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications / Q000601:surgery*; D010146:Pain / Q000209:etiology / Q000523:psychology; D011184:Postoperative Period; D057234:Preoperative Period; D013222:State Medicine; D013995:Time
keywords: Health services; Hip replacement; Osteoarthritis; Qualitative; Time; UK; Waiting lists