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Lori L. Grover, Kendall L. Krug, Kevin D. Frick; Clinical Decision Making in the Care of Patients with Chronic Vision Impairment. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4244.
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Very little is known about the decision making process of clinicians who treat patients with chronic vision impairment (VI) and patient-clinician communications. The purpose of this study is to investigate fundamental models of clinician decision making and patient-clinician interaction in the care of patients with chronic VI.
A pilot study was conducted using a convenience sample of 25 VI patients from the state of Kansas. Five hypothesized models of clinical decision making were considered as possible outcomes, and four hypothesized model factors were considered to represent each decision making model. Data from patient records were extracted to explore the type of decision making model(s) employed during the initial examination encounter based on two model factors: structure and framing of the decision, and decision process. Analysis was guided by a novel conceptual model theorized to elucidate structural, process and outcome components of the vision rehabilitation care process.
Of the five decision making models hypothesized to be employed in the treatment of patients with VI, findings indicate based on the model factors that two predominant models of decision making occurred in the clinical encounters of the study population: active informed consent and shared decision making. The normative shared decision making model was not well represented, in part due to a lack of decision support aids in the clinical setting and lack of documentation of patient decision aid availability outside of the clinical setting.
Findings indicate that shared decision making does occur in clinical vision rehabilitation practice. Although several limitations exist, this study provides the first insights into our understanding of the clinical decision making process employed by the vision rehabilitation clinician, and early quantification of clinician-patient interaction. Initial evidence supports the finding of several hypothesized clinical decision making models in use in the treatment of patients with chronic VI, allowing for further study of additional clinical providers and patient populations to refine our understanding of the hypothesized vision rehabilitation decision making process and related fundamental clinical decision making questions including how patient participation is defined in the VR care process.
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