Do persons with diabetes want to decide on their own when treating diabetic retinopathy? The intended role of the ophthalmologist - results of the DiabCheck^OCT+ Study.

Abstract

 

Purpose

 

Physicians are not always aware of the risk to patronize their patients. While some people explicitly request for a paternalistic approach, disempowerment could contribute to unintended passiveness and gaps in knowledge which are known to be associated with worse metabolic control, especially in diabetes. In order to assess the patient’s point of view on codetermination, a prospective survey was initiated to assess the preferences for shared decision-making in a representative cohort.

 

Methods

 

The DiabCheck^® trial was a non-interventional cross-sectional study of 810 adults in 3 secondary diabetes care centers during a period of 4 month. All patients of the investigator initiated study were included after confirmed diagnosis of diabetes and underwent a comprehensive eye examination. A questionnaire evaluated demographic characteristics, diabetes duration and type of treatment. Level of education and age were investigated as predictors of patients’ role preferences for decision-making. For categorical outcomes, χ²-test was used to test for significant differences in participants’ characteristics by group. For continuous outcomes, significant differences between strata were evaluated using a Wilcoxon Signed-Rank test (α=0.05).

 

Results

 

A majority of 74.3% (599 of 806) preferred shared decision-making. However, 17.4% selected a paternalistic approach with a decision-making only by the treating ophthalmologist. The preference for a patient-dominant decision was 8.3%. In contrast, 2.6% (21 of 806) wanted no medical and scientific information of the ophthalmologist.<br /> Participants wanting an ophthalmologist-dominant decision-making where significantly older (>60 years) and had a lower level of education (p<0.05). In this group, a wait-and-watch attitude was more frequently seen. However, participants with a higher level of education wished significantly more often to determine the preferred treatment alone (p<0.05). Even those in both groups, aiming for a unilateral decision mostly asked for a preceding exchange of information (186 of 806).

 

Conclusions

 

Most persons with diabetes want to be partners in the process of counseling and prefer shared treatment decision-making. Ophthalmologists should be aware of the patients' perspective in order to encourage an active and self-determined setting of individualized treatment targets.