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Paula Anne Newman-Casey, Sathya Ravilla, Haripriya Aravind, Vinoth Palanichamy, Manju Pillai, Vijayakumar Balakrishnan, Alan Robin; An Evaluation of Non-Physician Educators' Role In Enhancing Cataract Patient’s Surgical Knowledge and Satisfaction. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4546.
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To evaluate the effectiveness of the pre-surgical patient counseling system at the Aravind Eye Hospital in Madurai, India. Counselors are non-physician educators trained in counseling strategies and ophthalmology.
We administered a questionnaire to 60 patients with newly diagnosed visually significant cataracts and no other ocular pathology both before and after they underwent cataract counseling. The questionnaire measured their knowledge of cataract and cataract surgery and decisional conflict over whether to undergo surgery. The questionnaire assessed socio-demographic characteristics including age, sex, occupation, literacy status, education, insurance status, and whether the patient was the primary decision maker. After counseling, we measured patients’ overall satisfaction with the counseling services. We evaluated the counselors’ knowledge.
Both the patient knowledge scores and decisional conflict scores significantly improved following counseling (mean difference +2.0, p=0.004 and +8.4, p<0.0001, respectively). Multiple regression identified female gender, being illiterate, and being the primary decision maker as important factors in how much the counseling increased patient knowledge (β=2.5, p<0.001 for sex, β=1.7, p=0.04 for literacy and β=-1.5, p=0.06). 99% of patients reported that they were satisfied with the counseling system, and counselor knowledge score was significantly correlated to the patient satisfaction score (Pearson correlation coefficient 0.49, p<0.001). There was also a significant correlation between the patient satisfaction score and the change in patient knowledge score (Pearson correlation coefficient 0.28, p=0.03).
Training non-physician educators to counsel patients about cataract surgery is effective in improving patients’ knowledge about their condition, and in reducing their anxiety about making the decision to go through with the surgery. Counseling can be performed by a non-physician extender and is very important in reaching out to patients who have traditionally had more limited access to healthcare such as women, illiterate patients and patients who are not their own primary decision maker. Increased use of counseling might help to further reduce the global burden of cataract blindness.
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