Waiting for Care: a Study of Physical and Psychological Symptoms and Healthcare Utilization for Pain Whilst Waiting for Gynaecological Surgery

Abstract

There is a growing interest in the impact of waiting for surgery, a common experience for many Canadians. Pain and psychological symptoms prior to surgical management are frequently problems for women with gynaecological conditions, however minimal research was found to investigate pain and psychological symptoms in these women prior to surgery. Also pain is recognized to increase healthcare utilization, but this has not been previously examined in this population. The objectives of this research project were to examine levels of pain, psychological factors associated with pain and frequency of healthcare utilization due to pain in a population of women waiting for gynaecological surgery, predominantly undergoing hysterectomies. Four hundred and twenty nine women in a tertiary care centre in southeastern Ontario were included in the study. Anxiety was measured using the State Trait Anxiety Inventory (STAI), depression with the Centre for Epidemiologic Studies Depression Scale (CES-D), somatization using the Seven Symptom Screening Test (SSST) and catastrophizing was measured using an abbreviated coping strategies questionnaire (CSQ). Pain was assessed using the Brief Pain Inventory (BPI). Women also reported on their healthcare utilization for pain over the past 12 months. The length of wait was obtained from hospital waiting data. Results showed a moderate to severe pain intensity score occurred in 30.5% of women and a moderate to severe interference score in 31.5%. Being younger, married, employed and with high trait anxiety were factors associated with higher rates of healthcare utilization. High levels of depression, somatization and catastrophizing were associated with higher pain intensity and interference scores. This study supports the need for preoperative assessment of physical and psychological symptoms in women waiting for gynaecological surgery. Improving patients’ health prior to surgery will potentially reduce their healthcare demands on a financially constrained healthcare service.