Why Watchful Waiting With

Watchful waiting, also called expectant management or active surveillance, is a monitoring strategy used in medicine when the natural history of a condition is well understood and the potential benefits of treatment are not clearly established. It involves regular monitoring of the condition, with treatment initiated only if the condition worsens or changes in a way that suggests a need for intervention.

Reasons for watchful waiting:

- Lack of clear evidence of the effectiveness of treatment: When there is insufficient evidence to support the benefits of treatment compared to the potential risks, watchful waiting may be preferred.

- Minimal symptoms or slow progression: In cases where symptoms are mild or non-existent and the condition progresses slowly, watchful waiting can be an appropriate approach to avoid unnecessary treatment and its side effects.

- Balancing treatment benefits and risks: Watchful waiting allows for close monitoring to detect any signs of progression or deterioration, allowing timely intervention if necessary. It also minimizes the risks associated with unnecessary treatments.

- Patient preferences: Involving patients in decision-making and considering their preferences is essential in watchful waiting. Some patients may prefer to delay or avoid treatment until symptoms become more severe or impact their quality of life.

Conditions for watchful waiting:

- Well-defined natural history: Watchful waiting is most appropriate when the natural history of the condition is well understood, and the expected course of the disease is predictable.

- Appropriate monitoring tools: Regular monitoring is crucial in watchful waiting. This can include physical examinations, imaging tests, laboratory tests, or symptom assessments, depending on the condition.

- Clear criteria for intervention: Predefined criteria should be established to determine when intervention or treatment becomes necessary. These criteria may include specific symptom thresholds, changes in test results, or signs of disease progression.

- Shared decision-making: Watchful waiting should be a shared decision between the healthcare provider and the patient. The risks, benefits, and alternative options should be thoroughly discussed, ensuring the patient's understanding and involvement in the decision-making process.

Examples of conditions where watchful waiting may be used:

- Small, localized prostate cancers without aggressive features

- Certain non-aggressive thyroid nodules

- Benign prostatic hyperplasia (BPH) with mild symptoms

- Asymptomatic kidney cysts or small renal masses

- Asymptomatic carotid artery stenosis with low risk of stroke

- Some low-risk skin lesions or pre-cancerous conditions

It's important to note that watchful waiting is not the same as ignoring a condition. It involves close monitoring and regular assessments to ensure timely intervention if necessary. The decision to employ watchful waiting should be carefully considered in consultation with a healthcare professional, taking into account the specific circumstances and individual preferences of the patient.