Watchful waiting explained

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] [2]} active surveillance (especially active surveillance of prostate cancer),^[3] and masterly inactivity.^[4] The term masterly inactivity is also used in nonmedical contexts.^[5]

A distinction can be drawn between watchful waiting and medical observation,^[6] but some sources equate the terms.^{[7] [8]} 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;^[9] 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,^[10] 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^[11]
• otitis media^[12]
• inguinal hernia
• odd behaviors in infants
• non-symptomatic kidney stones
• gender dysphoria in children prior to the onset of puberty^{[13] [14]}

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.^[15] 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).^[16]

See also

• Public health surveillance
• Waiting in healthcare
• Monitoring (medicine)

External links

• Lymphoma Treatment: Watch and Wait
• Watchful Waiting and Monitoring Indolent Lymphomas
• Watchful Waiting: Chapter from Lymphoma Australia's "Your Journey Of Lymphoma Treatments" DVD

Notes and References

1. Book: Pestana . Carlos . Pestana's Surgery Notes . 7 April 2020 . Kaplan Test Prep . 978-1506254340 . 6–7 . Fifth . "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".
2. Web site: Definition of expectant management - NCI Dictionary of Cancer Terms.
3. Web site: Watchful Waiting or Active Surveillance for Prostate Cancer .
4. Vaile JC, Griffith MJ . Management of asymptomatic aortic stenosis: masterly inactivity but cat-like observation . Heart . 78 . 3 . 215–7 . September 1997 . 9391278 . 10.1136/hrt.78.3.215 . 484918.
5. Masterly Inactivity - TIME . https://web.archive.org/web/20080110120136/http://www.time.com/time/magazine/article/0,9171,816693,00.html . dead . January 10, 2008 . Time. 2010-05-27. 1952-08-18.
6. Web site: Australian Prostate Cancer Website .
7. Web site: Prostate cancer guide - MayoClinic.com .
8. Web site: Definition of watchful waiting - NCI Dictionary of Cancer Terms . January 1980 .
9. http://www.aap.org/healthtopics/earinfections.cfm American Academy of Pediatrics
10. Kendall C, Murray S . Is watchful waiting a reasonable approach for men with minimally symptomatic inguinal hernia? . CMAJ . 174 . 9 . 1263–4 . April 2006 . 16636325 . 10.1503/cmaj.060299 . 1435959.
11. Meredith LS, Cheng WJ, Hickey SC, Dwight-Johnson M . Factors associated with primary care clinicians' choice of a watchful waiting approach to managing depression . Psychiatr Serv . 58 . 1 . 72–8 . January 2007 . 17215415 . 10.1176/appi.ps.58.1.72-a . free .
12. Varrasso DA, Ashe D, Ruben R, Propp R . Watchful waiting for acute otitis media: are parents and physicians ready? . Pediatrics . 118 . 2 . 849–50 . August 2006 . 16882857 . 10.1542/peds.2005-2786 . 7808557 .
13. Peggy Cohen . Kettenis . Henriette Delemarre . van de Waal . Louis . Gooren . vanc . The Treatment of Adolescent Transsexuals: Changing Insights . The Journal of Sexual Medicine . 5 . 8 . 1892–1897 . August 2008 . 10.1111/j.1743-6109.2008.00870.x . 18564158 .
14. Annelou . de Vries . Peggy Cohen . Kettenis . vanc . Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach . Journal of Sexuality . 59 . 3 . 301–320 . March 2012 . 10.1080/00918369.2012.653300.
15. Katz DA, Littenberg B, Cronenwett JL . Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting . JAMA . 268 . 19 . 2678–86 . November 1992 . 1433687 . 10.1001/jama.268.19.2678.
16. Web site: Gundersen Lutheran - What is Outpatient Observation? .