Watchful waiting

Watchful waiting

Watchful waiting (also watch and wait or WAW) is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy is used. During this time, repeated testing may be performed.

Related terms include expectant management[1], active surveillance and masterly inactivity.[2] The term masterly inactivity is also used in nonmedical contexts.[3]

A distinction can be drawn between watchful waiting and medical observation,[4] but some sources equate the terms.[5][6] Usually, watchful waiting is an outpatient process and it may have a duration of months or years. In contrast, medical observation usually is an inpatient process, often involving frequent or even continuous monitoring, and may have a duration of hours or days.

Contents

Uses

Often watchful waiting is recommended in situations with a high likelihood of self-resolution, in situations where there is high uncertainty concerning the diagnosis, and in situations where the risks of intervention or therapy may outweigh the benefits.

Watchful waiting is often recommended for many common illnesses such as ear infections[7]; because the majority of cases resolve spontaneously, antibiotics will often be prescribed only after several days of symptoms. It is also a strategy frequently used in surgery prior to a possible operation,[8] when it is possible for a symptom (for example abdominal pain) to either improve naturally or become worse.

Other examples involve:

Process

Watchful waiting

In many applications, a key component of watchful waiting is the use of an explicit decision tree or other protocol to ensure a timely transition from watchful waiting to another form of management, as needed.[11] This is particularly common in the post-surgical management of cancer survivors, in whom cancer recurrence is a significant concern.

Medical observation

Usually, patients in observation, according to hospital policy, are only kept in observation for 24 or 48 hours before they will be discharged or admitted as an inpatient. Insurance can play a role in how "observation" is defined (for example, Medicare (US) does not support observation services for over 48 hours).[12]

See also

References

  1. ^ "ACS :: Expectant Management (Watchful Waiting)". http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Expectant_Therapy_Watching_and_Waiting_36.asp. 
  2. ^ Vaile JC, Griffith MJ (September 1997). "Management of asymptomatic aortic stenosis: masterly inactivity but cat-like observation". Heart 78 (3): 215–7. PMC 484918. PMID 9391278. http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=9391278. 
  3. ^ "Masterly Inactivity - TIME". Time. 1952-08-18. http://www.time.com/time/magazine/article/0,9171,816693,00.html. Retrieved 2010-05-27. 
  4. ^ "Australian Prostate Cancer Website". http://www.prostatehealth.org.au/phip_4.html?PHPSESSID=e1db774b4be02970795b9b7b95d7fb68#MonitoringNoTreatment. 
  5. ^ "Prostate cancer guide - MayoClinic.com". http://www.mayoclinic.com/health/prostate-cancer/PC99999/PAGE=PC00018. 
  6. ^ "Definition of watchful waiting - NCI Dictionary of Cancer Terms". http://nci.nih.gov/templates/db_alpha.aspx?CdrID=45942. 
  7. ^ American Academy of Pediatrics
  8. ^ Kendall C, Murray S (April 2006). "Is watchful waiting a reasonable approach for men with minimally symptomatic inguinal hernia?". CMAJ 174 (9): 1263–4. doi:10.1503/cmaj.060299. PMC 1435959. PMID 16636325. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=16636325. 
  9. ^ Meredith LS, Cheng WJ, Hickey SC, Dwight-Johnson M (January 2007). "Factors associated with primary care clinicians' choice of a watchful waiting approach to managing depression". Psychiatr Serv 58 (1): 72–8. doi:10.1176/appi.ps.58.1.72-a. PMID 17215415. http://ps.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=17215415. 
  10. ^ Varrasso DA, Ashe D, Ruben R, Propp R (August 2006). "Watchful waiting for acute otitis media: are parents and physicians ready?". Pediatrics 118 (2): 849–50. doi:10.1542/peds.2005-2786. PMID 16882857. http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=16882857. 
  11. ^ Katz DA, Littenberg B, Cronenwett JL (November 1992). "Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting". JAMA 268 (19): 2678–86. doi:10.1001/jama.268.19.2678. PMID 1433687. 
  12. ^ "Gundersen Lutheran - What is Outpatient Observation?". http://www.gundluth.org/web/misc/pbs.nsf/8a155831a7ba541b8625703600655a76/c850b081fba94992862572fa006013b9!OpenDocument. 

External links


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