Amsterdam UMC Locatie De Boelelaan, Amsterdam, The Netherlands.
Flevoziekenhuis, Almere, Netherlands.
BMJ Open. 2024 Aug 17;14(8):e085932. doi: 10.1136/bmjopen-2024-085932.
Patient-centredness of care during wait time before surgery can be improved. In this study we aimed to assess (1) patients' experiences with and preferences regarding wait time before surgery; (2) the impact of wait time on quality of life (QoL) and (3) which factors influence patients' wait time experience.
DESIGN, SETTING, PARTICIPANTS: We performed an exploratory sequential mixed-methods study among women with gynaecological cancer in two tertiary hospitals. We conducted semistructured interviews and identified aspects of QoL and factors that influenced wait time acceptability through thematic analysis. We developed a questionnaire from this thematic analysis which was completed by 97 women. Descriptive statistics and univariate and multivariate regression analyses were performed.
Average ideal wait time was 3.5 weeks (±1.7 weeks), minimum and maximum acceptable wait times were 2.2 and 5.6 weeks. Many patients scored above the threshold of the Hospital Anxiety and Depression Scale for anxiety (48%) or depression (34%), had sleeping problems (56%) or experienced pain (54%). A number of factors were more common in patients who indicated that their wait time had been too long: low education level (OR 7.4, 95% CI 0.5 to 5.0, p=0.007), time to surgery >4 weeks (OR 7.0, 95% CI 0.8 to 4.4, p=0.002) and experienced sleep disturbance (OR 3.27, 95% CI 0.0 to 3.1, p=0.05). If patients expectation of wait time was >4 weeks (OR 0.20, 95% CI -4.0 to -0.5 p=0008) or if patients experienced pain (OR 0.26, 95% CI -3.6 to -0.3, p=0.03), they less frequently indicated that wait time had been too long.
To improve patient-centredness of care, healthcare providers should aim to reduce wait time to 3-4 weeks and ensure that patients are well informed about the length of wait time and are aware of high levels of anxiety, depression and pain during this time. Future studies should evaluate what interventions can improve QoL during wait time.
可以提高手术前等待时间的以患者为中心程度。本研究旨在评估：（1）患者对手术前等待时间的体验和偏好；（2）等待时间对生活质量（QoL）的影响；（3）影响患者等待时间体验的因素。
设计、地点、参与者：我们在两家三级医院对妇科癌症女性进行了探索性序贯混合方法研究。我们进行了半结构式访谈，并通过主题分析确定了 QoL 方面和影响等待时间可接受性的因素。我们从该主题分析中开发了一份问卷，该问卷由 97 名女性完成。进行了描述性统计分析以及单变量和多变量回归分析。
平均理想等待时间为 3.5 周（±1.7 周），最小和最大可接受等待时间分别为 2.2 和 5.6 周。许多患者的焦虑症（48%）或抑郁症（34%）的医院焦虑和抑郁量表评分超过阈值，有睡眠问题（56%）或经历疼痛（54%）。在表示等待时间过长的患者中，许多因素更为常见：低教育水平（OR 7.4，95%CI 0.5 至 5.0，p=0.007），手术时间>4 周（OR 7.0，95%CI 0.8 至 4.4，p=0.002）和经历睡眠障碍（OR 3.27，95%CI 0.0 至 3.1，p=0.05）。如果患者对等待时间的期望>4 周（OR 0.20，95%CI -4.0 至 -0.5，p=0.0008）或患者经历疼痛（OR 0.26，95%CI -3.6 至 -0.3，p=0.03），他们表示等待时间过长的可能性较小。
为了提高以患者为中心的护理水平，医疗保健提供者应努力将等待时间缩短至 3-4 周，并确保患者充分了解等待时间，并意识到在此期间焦虑、抑郁和疼痛水平较高。未来的研究应评估哪些干预措施可以改善等待时间的 QoL。
