Patients' acceptance of waiting for cataract surgery: what makes a wait too long?

The patient's perspective about waiting for elective surgery is an important consideration in the management of waiting lists, yet it has received little attention to date. This study was undertaken to assess the acceptability of personal waiting times from the perspective of patients, and to examine waiting time and patient characteristics associated with the perception that a wait for cataract surgery is too long. The international prospective study was conducted in three sites with explicit waiting systems: Manitoba, Canada; Denmark; and Barcelona, Spain. Patients over the age of 50 years were recruited consecutively from ophthalmologists' practices at the time of their enlistment for first-eye cataract surgery. Anticipated waiting time, opinions about personal waiting time, and patients' visual and health characteristics were identified by means of telephone interviews. The 550 patients interviewed at the time of enlistment for surgery anticipated waits varying from < 1 to 24 months. Clinical visual acuity measures were obtained from patients' ophthalmologists/cataract surgeons. Results indicated that anticipated waiting time was the strongest predictor of patients' tolerance of waiting for cataract surgery. Patient dissatisfaction increased with the duration of the anticipated wait. Patients in all three sites were accepting of waits of three months or less, and considered waits exceeding six months to be excessive. Response to waits between three and six months varied across study sites. Patients with low tolerance for waiting had greater self-reported difficulty with vision, as assessed by a Cataract Symptom Score and expressed trouble with vision. Patients' acceptance of waiting was not associated with clinical visual acuity measures or socio-demographic characteristics. The patient perspective on acceptability of waiting times for cataract surgery suggests that restricting waiting times to less than six months and preferably less than three months and utilizing self-reported measures of visual difficulty in prioritizing patients may contribute to improved management of waiting systems. Patients are more tolerant of their personal waiting times than responses to questions about waiting for elective surgery in general would indicate, and appear to accept waiting times that are longer than those identified as reasonable by specialists.