Outline Implications

Having synthesized our and ideas evidence, practiced iteration and checked for bias, we should be prepared to describe the implications of how we, as individuals and communities, think about and address issues and support populations. We should be able to determine who is at risk or in need and possibly why as well as identify who is likely to benefit from particular responses – policies or programs – and who is not. Let’s return to the issue of waiting for hip and knee replacement surgery (TJA) as a concrete example of final implications.

The research on wait times for TJA suggests that women are less likely than men to get onto wait lists for a variety of reasons: because they have not discussed surgery with their doctors or been referred to specialist; because physicians may think that women’s pain is not as great or as significant as the women themselves report; because x-rays focus attention on visible joint damage rather than pain and impairment caused by joint damage, which seems to be different for women and men. In other words, women are not necessarily waiting for surgery – many of them are “waiting to wait”.

At the same time, it seems that when women do make it onto wait lists for surgery they are more likely than men to take themselves off the list. In some cases, women are uncertain that they will be able to manage their care following surgery and have fewer social supports to help with their recovery. So they take themselves off the wait list. Because women live longer, on average, than men, they are also less likely to have someone to care for them following surgery. So they take themselves off the wait list. In other cases, women are more likely than men to be unpaid caregivers and may not be able to pay or arrange for someone else to take over their responsibilities while they have and recover from surgery. So they take themselves off the wait list. All of these factors combine to create a situation in which women are less likely than men to get new hips or knees when they need them.

What are the implications of this analysis for research as well as for policy and program development and service delivery? We can see the need for a deeper and broader understanding of who is at risk and/or in need of hip and knee replacement surgery. Right now, we simply do not have enough evidence that is sex-disaggregated, addresses the role of gender, or considers the needs and experiences of diverse populations. The current approach to managing wait times in Canada also appears to be biased in that it maintains gendered and work hierarchies, ignores the possibility of differences among sub-populations, and applies a double standard of assessment and treatment to women and men. As a result, the management of wait times runs the risk of deepening health inequities among those needing or waiting for hip and knee replacement surgery.

Image source: Used with permission of Woman and Health Care Reform

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