April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Decision Making in Cataract Surgery
Author Affiliations & Notes
  • Roni M Shtein
    Ophthalmology, University of Michigan-Kellogg Eye Ctr, Ann Arbor, MI
  • Taylor Blachley
    Ophthalmology, University of Michigan-Kellogg Eye Ctr, Ann Arbor, MI
  • Paul P Lee
    Ophthalmology, University of Michigan-Kellogg Eye Ctr, Ann Arbor, MI
  • David C Musch
    Ophthalmology, University of Michigan-Kellogg Eye Ctr, Ann Arbor, MI
    Epidemiology, University of Michigan-School of Public Health, Ann Arbor, MI
  • Angela Fagerlin
    Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
    Psychology, University of Michigan, Ann Arbor, MI
  • Brian J Zikmund-Fisher
    Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
    Health Behavior and Health Education, University of Michigan-School of Public Health, Ann Arbor, MI
  • Footnotes
    Commercial Relationships Roni Shtein, None; Taylor Blachley, None; Paul Lee, None; David Musch, None; Angela Fagerlin, None; Brian Zikmund-Fisher, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 1563. doi:https://doi.org/
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    • Get Citation

      Roni M Shtein, Taylor Blachley, Paul P Lee, David C Musch, Angela Fagerlin, Brian J Zikmund-Fisher; Decision Making in Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1563. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To assess the relationship of patient-physician communication with patient perceptions of cataract surgery.

 
Methods
 

The DECISIONS study was a computer-assisted telephone interview survey assessing decision-making in 9 common medical decisions, including cataract surgery. A nationally representative sample of 3010 adults in households with telephones in the US completed interviews. Of these, 282 respondents either had or discussed cataract surgery with their health care provider (HCP) in the previous 2 years and were included in the present analysis. Univariate and multivariate analyses were performed to determine the relationships of four factors - patient-physician communication, decision-making, factual knowledge about cataract surgery, and sociodemographic information - with patient confidence in their decision and their perceived success of cataract surgery.

 
Results
 

96% of respondents indicated they discussed reasons to have surgery with their HCP but only 44% indicated they discussed reasons not to have surgery. African-Americans and females were significantly less likely to have discussed the reasons not to have surgery than whites (p=.0004) and males (p=.005). While 45% of individuals felt very well informed prior to making the decision about surgery, there was no relationship between feeling informed and factual knowledge about cataract surgery. Knowledge scores also did not influence whether individuals felt confident in their decision about whether to have cataract surgery, but feeling informed was strongly associated with confidence (p<.0001). When asked to rate the success of their cataract surgery, most respondents indicated it was successful, but only 29% of respondents felt their surgery was very successful. Elements of patient-physician communication were not significantly associated with perceived success of surgery. Compared to those who reported a shared decision-making process with their HCP, individuals who reported their HCP made the decision about whether to proceed with surgery had 5.6 times higher odds of indicating their surgery was very successful.

 
Conclusions
 

From the patient perspective, patient-physician communication about cataract surgery is highly variable, without consistent discussion of pros, cons, and patient preferences. In this cohort, shared decision-making for cataract surgery did not produce the intended outcomes of improving patient knowledge, confidence in their decision, or perceived success of surgery.

 
Keywords: 445 cataract • 743 treatment outcomes of cataract surgery • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower  
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