Exploring the psychological morbidity of waiting for sinus surgery using a mixed methods approach

Abstract

BackgroundPatients with chronic rhinosinusitis (CRS) often have to endure significant wait times for endoscopic sinus surgery (ESS). The pyschiatric impact of placement on a waitlist for ESS has not been explored.MethodsQuestionnaires measuring CRS symptom severity and health-related anxiety and stress (SNOT-22, HADS, WPAI-GH) were sent to patients diagnosed with CRS and currently on a waitlist for ESS. Fifteen representative waitlisted patients participated in one-on-one semi-structured interviews discussing their experience with their wait for ESS. A deductive thematic analysis was used to interpret the interview data using a quantitative driven mixed methods analysis.ResultsParticipants waiting for ESS reported worsening clinical symptomatology during their waiting period. Participants reported waitlist and CRS impact on both work and social aspects of their lives. The HADS scale showed no overall significant level of depression or anxiety in the HADS screening questionnaire. The qualitative data describe the effects of the symptom burden of CRS.ConclusionsPatients waitlisted for ESS did not demonstrate any significant level of psychiatric distress, however variability exists. The qualitative arm of this study elucidates how patients cope with their wait.

Wait times for endoscopic sinus surgery influence patient‐reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria

“…It is interesting to note that prolonged wait times do not alter psychological dysfunction. This observation is in keeping with a prior study from our institution, where we found that there was no correlation between the length of wait time and degree of psychological distress in CRS patients who failed AMT . Subjects felt that they had no difficulty coping with their symptoms while they waited for ESS, nor did they feel their disease‐specific symptoms contributed to feeling depressed.…”

“…Our study did not capture the SNOT‐22 at the time of surgery, and thus we cannot conclude whether preoperative disease‐specific QOL varied with wait times. The current literature reports that patients receiving ongoing medical therapy while awaiting ESS face an absolute increase in SNOT‐22 global scores during this time period . Our presumption was that patients across our cohort were equally impacted in the preoperative phase, and therefore experienced the same degree of worsening in disease‐specific QOL.…”

“…Subjects felt that they had no difficulty coping with their symptoms while they waited for ESS, nor did they feel their disease‐specific symptoms contributed to feeling depressed. Instead, they felt they could cope with their illness while being on the waitlist because they felt comforted that a treatment plan was established . However, these findings may be unique to our universal publicly funded healthcare system or to the patients managed by a specific practitioner, where patients may generally tolerate longer wait times and are prepared for this at time of consent.…”

Understanding the Patient Experience of Severe, Recurrent, Bilateral Nasal Polyps: A Qualitative Interview Study in the United States and Germany

“…The primary symptoms of nasal polyps to emerge from these qualitative interviews were consistent with those found within the broader published research literature as well as social media sources, with nasal congestion being the consistent symptom reported across all interviews and sources. [16][17][18] Recent studies have also identified the importance of nasal congestion or obstruction, nasal drip, and loss of smell in patients with CRS with nasal polyps. 23,24 Building on the identification of symptoms as relevant to the population with nasal polyps, participants in the current study discussed their symptoms in terms of frequency, duration, and severity, providing an in-depth understanding of the symptomatology, the specific characteristics of which were not detailed within the current published literature.…”

“…jval.2019.11.005). [16][17][18] These articles reported studies conducted between 2015 and 2016 in the United Kingdom and Canada and included male and female patients 18 to 68 years of age with CRS with or without nasal polyps or fungal allergic rhinitis. Face-toface patient qualitative interviews and qualitative analysis techniques were used in each of the studies.…”