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Development and preliminary evaluation of a decision aid to support informed choice among patients with age-related cataract

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Abstract

Objective

Shared decision making and meaningful patient involvement are key in improving cataract treatment outcomes, but no decision aid has been formally developed and validated for this purpose. Our aims were to develop a patient decision aid to guide patients’ decision about when to undergo cataract surgery, and to determine patient’s comprehension and booklet’s acceptability.

Methods

The patient decision aid was developed and included evidence-based information about general cataract, its benefits, risks of treatment options, and value clarification exercise. A total of 30 patients with age-related cataract aged between 50 and 80 years were interviewed after using either the patient decision aid (n = 15) or the traditional education booklet (n = 15).

Results

The patients who received the decision aid agreed that the information was new (n = 15, 100%), the length of the aid was “just about right” (n = 13, 87%), the information was clear and easy to understand (n = 13, 87%), the decision aid was helpful in making decision (n = 13, 87%) and would like to recommend this decision aid to others (n = 14, 93%).

Conclusions

The decision aid was assessed positively by patients with age-related cataract. There is a need for its further verification in the context of primary eye care setting.

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Data availability

Anonymized patient-level data are available on request from the authors.

References

  1. Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR (2017) Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis. Lancet Glob Health 5(12):e1221–e1234. https://doi.org/10.1016/s2214-109x(17)30393-5

    Article  PubMed  Google Scholar 

  2. Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS (2017) Cataracts. Lancet (Lond, Engl) 390(10094):600–612. https://doi.org/10.1016/s0140-6736(17)30544-5

    Article  Google Scholar 

  3. Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Galloway P, Canning C, Sparrow JM (2009) The Cataract National Dataset electronic multi-centre audit of 55,567 operations: updating benchmark standards of care in the United Kingdom and internationally. Eye (Lond, Engl) 23(1):38–49. https://doi.org/10.1038/sj.eye.6703015

    Article  CAS  Google Scholar 

  4. Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Elliott D, Donovan JL (2018) Cataract surgery patient-reported outcome measures: a head-to-head comparison of the psychometric performance and patient acceptability of the Cat-PROM5 and Catquest-9SF self-report questionnaires. Eye (Lond, Engl) 32(4):788–795. https://doi.org/10.1038/eye.2017.297

    Article  CAS  Google Scholar 

  5. Liang YB, Friedman DS, Wong TY, Zhan SY, Sun LP, Wang JJ, Duan XR, Yang XH, Wang FH, Zhou Q, Wang NL (2008) Prevalence and causes of low vision and blindness in a rural chinese adult population: the Handan Eye Study. Ophthalmology 115(11):1965–1972. https://doi.org/10.1016/j.ophtha.2008.05.030

    Article  PubMed  Google Scholar 

  6. Smith SK, Trevena L, Simpson JM, Barratt A, Nutbeam D, McCaffery KJ (2010) A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial. BMJ (Clin Res Ed) 341:c5370. https://doi.org/10.1136/bmj.c5370

    Article  Google Scholar 

  7. Hersch J, Barratt A, Jansen J, Irwig L, McGeechan K, Jacklyn G, Thornton H, Dhillon H, Houssami N, McCaffery K (2015) Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. Lancet (Lond, Engl) 385(9978):1642–1652. https://doi.org/10.1016/s0140-6736(15)60123-4

    Article  Google Scholar 

  8. Lundström M, Goh PP, Henry Y, Salowi MA, Barry P, Manning S, Rosen P, Stenevi U (2015) The changing pattern of cataract surgery indications: a 5-year study of 2 cataract surgery databases. Ophthalmology 122(1):31–38. https://doi.org/10.1016/j.ophtha.2014.07.047

    Article  PubMed  Google Scholar 

  9. Lundström M, Barry P, Henry Y, Rosen P, Stenevi U (2013) Visual outcome of cataract surgery; study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg 39(5):673–679. https://doi.org/10.1016/j.jcrs.2012.11.026

    Article  PubMed  Google Scholar 

  10. Olson RJ, Braga-Mele R, Chen SH, Miller KM, Pineda R, Tweeten JP, Musch DC (2017) Cataract in the adult eye preferred practice pattern®. Ophthalmology 124(2):P1–p119. https://doi.org/10.1016/j.ophtha.2016.09.027

    Article  PubMed  Google Scholar 

  11. Day AC, Wormald R, Coronini-Cronberg S, Smith R (2016) The royal college of ophthalmologists’ cataract surgery commissioning guidance: executive summary. Eye (Lond, Engl) 30(3):498–502. https://doi.org/10.1038/eye.2015.271

    Article  CAS  Google Scholar 

  12. Cataract: what you should know (2015) https://www.nei.nih.gov/sites/default/files/health-pdfs/WYSK_Cataract_English_Sept2015_PRINT.pdf. Accessed 7 Mar 2019

  13. Smith SK, Trevena L, Barratt A, Dixon A, Nutbeam D, Simpson JM, McCaffery KJ (2009) Development and preliminary evaluation of a bowel cancer screening decision aid for adults with lower literacy. Patient Educ Couns 75(3):358–367. https://doi.org/10.1016/j.pec.2009.01.012

    Article  PubMed  Google Scholar 

  14. Hibbard JH, Peters E (2003) Supporting informed consumer health care decisions: data presentation approaches that facilitate the use of information in choice. Annu Rev Public Health 24:413–433. https://doi.org/10.1146/annurev.publhealth.24.100901.141005

    Article  PubMed  Google Scholar 

  15. Doak CCDL, Root JH (1996) Teaching patients with low literacy skills, 2nd edn. J.B. Lippincott, Philadelphia

    Google Scholar 

  16. McCarty CA, Mukesh BN, Dimitrov PN, Taylor HR (2003) Incidence and progression of cataract in the Melbourne Visual Impairment Project. Am J Ophthalmol 136(1):10–17. https://doi.org/10.1016/s0002-9394(02)01844-5

    Article  PubMed  Google Scholar 

  17. Leske MC, Chylack LT Jr, He Q, Wu SY, Schoenfeld E, Friend J, Wolfe J (1997) Incidence and progression of cortical and posterior subcapsular opacities: the Longitudinal Study of Cataract. The LSC Group. Ophthalmology 104(12):1987–1993. https://doi.org/10.1016/s0161-6420(97)30043-8

    Article  CAS  PubMed  Google Scholar 

  18. Leske MC, Chylack LT, Wu SY, Schoenfeld E, He Q, Friend J, Wolfe J (1996) Incidence and progression of nuclear opacities in the Longitudinal Study of Cataract. Ophthalmology 103(5):705–712. https://doi.org/10.1016/s0161-6420(96)30625-8

    Article  CAS  PubMed  Google Scholar 

  19. Will I et al (2013) An introduction to patient decision aids. BMJ (Clin Res Ed) 347:f4147. https://doi.org/10.1136/bmj.f4147

    Article  Google Scholar 

  20. Wong TY (2001) Effect of increasing age on cataract surgery outcomes in very elderly patients. BMJ (Clin Res Ed) 322(7294):1104–1106. https://doi.org/10.1136/bmj.322.7294.1104

    Article  CAS  Google Scholar 

  21. Matlock DD, Spatz ES (2014) Design and testing of tools for shared decision making. Circ Cardiovasc Qual Outcomes 7(3):487–492. https://doi.org/10.1161/circoutcomes.113.000289

    Article  PubMed  Google Scholar 

  22. Shen M, Hu M, Liu S, Chang Y, Sun Z (2015) Assessment of the Chinese Resident Health Literacy Scale in a population-based sample in South China. BMC Public Health 15:637. https://doi.org/10.1186/s12889-015-1958-0

    Article  PubMed  PubMed Central  Google Scholar 

  23. Patients waiting more than 18 weeks for surgery set to double to 1 million (2018) https://www.nhsconfed.org/news/2018/08/patients-waiting-more-than-18-weeks-for-surgery-set-to-double-to-1-million. Accessed 7 March 2019

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Funding

This study was funded by the National Natural Science Foundation of China (81530028; 81721003), the Guangdong Province Science and Technology Plan (2014B020228002), the National Key Basic Research and 973 Development Program of China (2015CB964600), Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program, Clinical Innovation Research Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory (2018GZR0201001); the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University. The authors designed, conducted and reported the study independently of the funding body throughout.

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Authors and Affiliations

Authors

Contributions

Yingfeng Z, BQ, WS, CW, SC, MH, and YL contributed to the conception and design of the study and study protocol. LJ performed statistical analysis. Yuxin Z oversaw data acquisition and implementation on site. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Yingfeng Zheng or Yizhi Liu.

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Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

The research was approved by the Zhongshan Ophthalmic Center Ethics Committee (Approval No.: 2017KYPJ066). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Patient and public involvement

We conducted a focus group study involving 30 patients with an initial diagnosis of age-related cataract. The patients assisted in refining the decision booklet by making suggestions. The interview allowed us to assess the acceptability and comprehensibility of the booklet.

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Zheng, Y., Qu, B., Shi, W. et al. Development and preliminary evaluation of a decision aid to support informed choice among patients with age-related cataract. Int Ophthalmol 40, 1487–1499 (2020). https://doi.org/10.1007/s10792-020-01318-3

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  • DOI: https://doi.org/10.1007/s10792-020-01318-3

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