Watchful waiting
{{Short description|Clinical management approach}}
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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,{{cite book |last1=Pestana |first1=Carlos |title=Pestana's Surgery Notes |date=7 April 2020 |publisher=Kaplan Test Prep |isbn=978-1506254340 |pages=6–7 |edition=Fifth |quote="Signs of a fracture affecting the base of the skull include raccoon eyes, rhinorrhea, and otorrhea or ecchymosis behind the ear. Expectant management is the rule. From our perspective, the significance of a base of the skull fracture is that it indicates that the patient sustained very severe head trauma"}}{{cite web |url=https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=616061 |title=Definition of expectant management - NCI Dictionary of Cancer Terms}} active surveillance (especially active surveillance of prostate cancer),{{cite web |url=https://www.cancer.org/cancer/prostate-cancer/treating/watchful-waiting.html |title=Watchful Waiting or Active Surveillance for Prostate Cancer }} and masterly inactivity.{{cite journal |vauthors=Vaile JC, Griffith MJ |title=Management of asymptomatic aortic stenosis: masterly inactivity but cat-like observation |journal=Heart |volume=78 |issue=3 |pages=215–7 |date=September 1997 |pmid=9391278 |doi= 10.1136/hrt.78.3.215 |url= |pmc=484918}} The term masterly inactivity is also used in nonmedical contexts.{{cite magazine |url=http://www.time.com/time/magazine/article/0,9171,816693,00.html |archive-url=https://web.archive.org/web/20080110120136/http://www.time.com/time/magazine/article/0,9171,816693,00.html |url-status=dead |archive-date=January 10, 2008 |title=Masterly Inactivity - TIME |magazine= Time|access-date= 2010-05-27| date=1952-08-18}}
A distinction can be drawn between watchful waiting and medical observation,{{cite web |url=http://www.prostatehealth.org.au/phip_4.html?PHPSESSID=e1db774b4be02970795b9b7b95d7fb68#MonitoringNoTreatment |title=Australian Prostate Cancer Website }} but some sources equate the terms.{{cite web |url=http://www.mayoclinic.com/health/prostate-cancer/PC99999/PAGE=PC00018 |title=Prostate cancer guide - MayoClinic.com }}{{cite web |url=http://nci.nih.gov/templates/db_alpha.aspx?CdrID=45942 |title=Definition of watchful waiting - NCI Dictionary of Cancer Terms |date=January 1980 }} Usually, watchful waiting is an outpatient process and may have a duration of months or years. In contrast, medical observation is usually an inpatient process, often involving frequent or even continuous monitoring and may have a duration of hours or days.
Medical uses
Often watchful waiting is recommended in situations with a high likelihood of self-resolution if there is high uncertainty concerning the diagnosis, and the risks of intervention or therapy may outweigh the benefits.
Watchful waiting is often recommended for many common illnesses such as ear infections in children;[http://www.aap.org/healthtopics/earinfections.cfm American Academy of Pediatrics] {{webarchive |url=https://web.archive.org/web/20070614130605/http://www.aap.org/healthtopics/earinfections.cfm |date=June 14, 2007 }} 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,{{cite journal |vauthors=Kendall C, Murray S |title=Is watchful waiting a reasonable approach for men with minimally symptomatic inguinal hernia? |journal=CMAJ |volume=174 |issue=9 |pages=1263–4 |date=April 2006 |pmid=16636325 |doi=10.1503/cmaj.060299 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=16636325 |pmc=1435959}} when it is possible for a symptom (for example abdominal pain) to either improve naturally or become worse.
Other examples include:
- the diagnosis and treatment of benign prostatic hyperplasia
- depression{{cite journal |vauthors=Meredith LS, Cheng WJ, Hickey SC, Dwight-Johnson M |title=Factors associated with primary care clinicians' choice of a watchful waiting approach to managing depression |journal=Psychiatr Serv |volume=58 |issue=1 |pages=72–8 |date=January 2007 |pmid=17215415 |doi=10.1176/appi.ps.58.1.72-a |url=http://ps.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=17215415|doi-access=free }}
- otitis media{{cite journal |vauthors=Varrasso DA, Ashe D, Ruben R, Propp R |title=Watchful waiting for acute otitis media: are parents and physicians ready? |journal=Pediatrics |volume=118 |issue=2 |pages=849–50 |date=August 2006 |pmid=16882857 |doi=10.1542/peds.2005-2786 |s2cid=7808557 |url=http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=16882857|url-access=subscription }}
- inguinal hernia
- odd behaviors in infants
- non-symptomatic kidney stones
- gender dysphoria in children prior to the onset of puberty{{cite journal |first1=Peggy Cohen |last1=Kettenis |first2=Henriette Delemarre |last2=van de Waal |first3=Louis |last3=Gooren |name-list-style=vanc |title=The Treatment of Adolescent Transsexuals: Changing Insights |journal=The Journal of Sexual Medicine |volume=5 |issue=8 |pages=1892–1897 |date=August 2008 |doi=10.1111/j.1743-6109.2008.00870.x |pmid=18564158 |url=https://onlinelibrary.wiley.com/doi/full/10.1111/j.1743-6109.2008.00870.x|url-access=subscription }}{{cite journal |first1=Annelou |last1=de Vries |first2=Peggy Cohen |last2=Kettenis |name-list-style=vanc |title=Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach |journal=Journal of Sexuality |volume=59 |issue=3 |pages=301–320 |date=March 2012 |doi=10.1080/00918369.2012.653300|url=https://www.tandfonline.com/doi/abs/10.1080/00918369.2012.653300|url-access=subscription }}
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.{{cite journal |vauthors=Katz DA, Littenberg B, Cronenwett JL |title=Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting |journal=JAMA |volume=268 |issue=19 |pages=2678–86 |date=November 1992 |pmid=1433687 |doi= 10.1001/jama.268.19.2678}} 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 kept in observation for only 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, US Medicare does not support observation services for over 48 hours).{{cite web |url=http://www.gundluth.org/web/misc/pbs.nsf/8a155831a7ba541b8625703600655a76/c850b081fba94992862572fa006013b9!OpenDocument |title=Gundersen Lutheran - What is Outpatient Observation? }}
See also
References
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External links
- [http://www.lymphomainfo.net/therapy/watchandwait.html Lymphoma Treatment: Watch and Wait]
- [http://www.lymphomation.org/watchfulwaiting.htm Watchful Waiting and Monitoring Indolent Lymphomas]
- [http://www.lymphoma.org.au/understanding-treatments/watch-and-wait Watchful Waiting: Chapter from Lymphoma Australia's "Your Journey Of Lymphoma Treatments" DVD]