Abstract
Purpose :
During anti-VEGF treatment patients are subjected to frequent invasive intravitreal injections while the effects are uncertain; for one in three patients this has negative consequences for their mental health. Therefore, a guided Internet-based self-help course, following the principles of cognitive behavioral therapy (called E-PsEYE), was developed and tested in a large randomized controlled trial (RCT). Patients were referred by their ophthalmologist to follow E-PsEYE individually in their own homes and were guided digitally and by telephone by a social worker from a low vision service. The purpose of this qualitative study was to evaluate barriers and facilitators to use this novel intervention in future Dutch clinical practice.
Methods :
Semi-structured interviews were performed with patients (n=8), eye care professionals from three large Dutch hospitals (i.e. heads of ophthalmology departments (n=2), ophthalmologists (n=4) and support staff (n=3)), low vision rehabilitation professionals from two nationally operating low vision services (i.e. managers (n=2), social workers (n=6)) and a health insurer. All interviews were recorded by a digital voice recorder and transcribed verbatim. A thematic approach was used to analyze the data using the conceptual framework of Fleuren et al.
Results :
Individual perceptions on e-health, based on (lack of) knowledge and self-efficacy, either impeded or facilitated the use of E-PsEYE in both patients and low vision rehabilitation staff. An important barrier for eye care professionals were lack of time and self-efficacy in addressing patients’ mental health and referring them before the end-stage of the disease. Moreover, the vision loss not meeting WHO criteria in many patients receiving anti-VEGF were expected to result in difficulties to enroll patients in low vision services and to ensure coverage of healthcare costs.
Conclusions :
Different barriers and facilitators were found on the individual level and in the interaction between stakeholders and their context. Implementation strategies that focus on these different aspects may optimize the use of E-PsEYE in addressing mental health in patients who receive anti-VEGF treatment. Results of the RCT may additionally shed light on the acceptability of E-PsEYE in the near future regarding its cost-effectiveness from a societal perspective.
This is a 2020 ARVO Annual Meeting abstract.