Llewellyn-Thomas H, Thiel E, Paterson M, Naylor D
Sunnybrook Health Science Centre, North York, Ontario, Canada.
J Health Serv Res Policy. 1999 Apr;4(2):65-72. doi: 10.1177/135581969900400203.
To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting.
Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement.
Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P < 0.0001).
Most patients reject waiting 6 months for elective CABG, even if offered along with a halving in surgical mortality (from 2% to 1%). Intolerance for further delay seems to be determined primarily by patients' attachment to their scheduled surgical dates. Many also have severely inflated perceptions of their risk of myocardial infarction in the queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.
了解患者对于非紧急冠状动脉旁路移植术（CABG）可接受的最长等待时间（MAWT），并确定MAWT是否与等待时间的先前预期、症状负担、预期缓解程度或等待期间心肌梗死的感知风险相关。
72名等待择期CABG手术的患者在两种假设但合理的选择之间进行抉择：等待1个月，手术死亡率为2%；等待6个月，手术死亡率为1%。如果受访者选择6个月/低风险选项，则将6个月选项中的等待时间上调；如果他们选择1个月/高风险选项，则下调等待时间，直至达到MAWT转换点。患者还报告了他们预期的等待时间、等待期间心肌梗死的感知风险、当前功能、预期功能改善情况以及该改善的价值。
只有17名（24%）患者选择了6个月/1%风险选项，而55名（76%）患者选择了1个月/2%风险选项。MAWT的中位数为2个月；分数范围为1至12个月（有两个异常值）。许多人认为，如果等待1个月（上四分位数，≥1.45%）或6个月（上四分位数，≥10%），心肌梗死的累积风险很高。然而，MAWT分数仅与预期等待时间相关（r = 0.47；P < 0.0001）。
大多数患者拒绝等待6个月进行择期CABG手术，即使手术死亡率减半（从2%降至1%）。对进一步延迟的不耐受似乎主要由患者对预定手术日期的执着决定。许多人对排队等待期间心肌梗死的风险也有严重夸大的认知。这些结果表明需要采取干预措施来改变患者不准确的风险认知，特别是如果预定的手术日期必须推迟。
