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