Background: "Let's go." "We can't." "Why not?" "We're waiting for Godot."Through the eyes of Samuel Beckett's protagonists we see that waiting can sometimes become intolerable. There is ample evidence to suggest that the concept of waiting in the context of healthcare delivery is a phenomenon that should be of interest to healthcare practitioners.
Objectives/purpose: The specific purpose of this review was to systematically examine scientific literature in order to identify the phenomenon of waiting in the context of healthcare. To this end the questions addressed in this review were:
1. What are the different types of waiting that occur when patients and families engage with healthcare delivery systems?
2. How do patients and families describe the experience of waiting while engaging with the healthcare delivery system?
3. What emotions are expressed as a result of having to wait while engaging with the healthcare system?
4. What is the experience of being on a "wait list" to receive healthcare services?
Types of participants
Patients, family members and/or significant others, of any age who experience the phenomenon of waiting in the context of the healthcare system.
Types of intervention(s)/phenomena of interest
This review considered research on the experiences of patients, family members and/or significant others who must wait for something as a result of engaging with the healthcare system.
Types of studies
This qualitative review considered studies that focused on qualitative data including but not limited to designs such as phenomenology, grounded theory, qualitative descriptive and ethnography. Mixed method studies with narrative description and patient voice were also considered. Grey literature such as research reports and dissertations were also included.
Search strategy: Key data bases including CINAHL, PubMed and SCOPUS were searched. The search strategy aimed to find both published and unpublished studies. We used a three-step search strategy in each component of the review. Studies were limited to English language papers. There were no limitations placed on the time line for study inclusion because we were unsure as to when the first research on this topic was conducted.
Methodological quality: Qualitative research papers selected for appraisal were assessed by two independent reviewers for methodological quality prior to inclusion in the review. The two reviewers used the standardized critical appraisal instruments from the Joanna Briggs Institute, specifically the Qualitative Assessment and Review Instrument (JBI-QARI).
Data collection: Qualitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-QARI.
Data synthesis: The data were synthesized using the Joanna Briggs Institute approach of meta-synthesis by meta-aggregation using JBI-QARI software and methods.
Results: Thirty-nine studies were included in the review. Ninety-three findings were aggregated into nine categories resulting in two synthesized findings. The syntheses indicate that waiting is a fearful, turbulent experience and one in which the healthcare system affords patients, families and/or significant others little opportunity to have the power to influence time and outcomes. A disconnect exists between healthcare system providers and patients, families and/or significant others regarding the meaning of waiting. For those who work in healthcare waiting is part of the culture, and is considered routine and normalized. For those who must wait the waiting is personal, fearful, and sometimes tortuous.
The included studies provided data about how patients, families and/or significant others experienced waiting in the context of the healthcare system. Of these studies, 16 employed phenomenology as a methodology:13 were qualitative descriptive; six were grounded theory; two were ethnography, one was mixed method and one was narrative inquiry. Only the qualitative aspect of the mixed method study was relevant to the research question and included in the meta-synthesis. All studies adopted appropriate qualitative and mixed method approaches. The studies were carried out in the United States, Canada, United Kingdom, Australia and Sweden.
Conclusions: A disconnect exists between healthcare system providers and patients, families and/or significant others regarding the meaning of waiting. But for those who work in healthcare, waiting is part of the culture, and is considered routine and normalized. For those who must wait, the waiting is personal, fearful and sometimes torturous. Feelings of frustration and anxiety were described frequently. Healthcare providers may be able to lessen the impact of the experience through a variety of empathic interventions. These might include giving frequent information, treating patients with a warm demeanor, acknowledging that the wait is difficult, helping people feel understood and being truthful about how long the wait might realistically be.
Implications for practice: Health care organizations need to be aware of the anxiety and stress experienced by families and significant others who are awaiting results of lab tests, diagnostic studies and other procedures. A mechanism of support should be in place. Many feel ignored and powerless while experiencing this wait. Anxiety and stress associated with waiting may also impact patients' understanding of important healthcare information. Additionally, healthcare organizations need to be cognizant of the complexities of the environment/work culture that may unknowingly promote anxiety and stress in patients/families related to waiting. Long waiting time is frequently associated with less satisfaction of care. Policies and procedures that address waiting concerns in all contexts need to be developed and implemented.
Implications for research: Further research is needed on the types of interventions that would ease the burden of waiting for patients and their significant others. The efficacy of the role of nurse navigators is poorly reported. Strategies that assist families to cope with waiting while a loved one is in surgery, lengthy procedures or intensive care units should be explored.