Gilbert Celeste, Keay Lisa, Palagyi Anna, Do Vu Quang, McCluskey Peter, White Andrew, Carnt Nicole, Stapleton Fiona, Laba Tracey-Lea
The George Institute for Global Health, The University of New South Wales, Newtown, New South Wales, Australia.
School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.
Clin Exp Optom. 2018 May;101(3):363-371. doi: 10.1111/cxo.12653. Epub 2018 Jan 17.
It is critical to consult patients to develop patient-centred cataract surgery care. We aimed to identify attributes patients consider when making decisions about cataract surgery in an Australian context, where both publicly and privately funded surgery are available. This is the first step in investigating how decisions are made about cataract surgery services.
This observational qualitative study was undertaken in two public hospitals and one private practice in Sydney, Australia. The study involved 19 women and men with age-related cataracts and no previous cataract surgery, aged > 18 years, able to speak conversational English or Mandarin. A multi-stage attribute development process was followed, including: literature review, semi-structured interviews with surgery candidates in three eye clinics, and review by an expert panel. The main outcome measures were primary attributes for making choices about cataract surgery.
Wait time, cost, institutional reputation, surgeon experience and travel time were identified as principal attributes; lower value was placed on consultation length and accessibility. Non-English speaking participants indicated greater interest in pre-operative information than English speakers, but expressed trust in the Australian healthcare system.
Findings suggest individuals prioritise attributes which consume time or incur costs when accessing care (wait time, cost and travel time). They also consider factors associated with the outcome of their cataract surgery (surgeon experience and institutional reputation). Similar to other decision-making processes, patients are likely to trade between these different attributes depending on their personal preferences and circumstances.
咨询患者以制定以患者为中心的白内障手术护理至关重要。我们旨在确定在澳大利亚背景下，患者在决定是否进行白内障手术时所考虑的因素，在澳大利亚，公立和私立资助的手术均可获得。这是调查如何做出白内障手术服务决策的第一步。
这项观察性定性研究在澳大利亚悉尼的两家公立医院和一家私人诊所进行。该研究涉及19名患有年龄相关性白内障且此前未接受过白内障手术的男性和女性，年龄大于18岁，能够说英语或普通话进行日常交流。遵循了一个多阶段的属性开发过程，包括：文献综述、在三家眼科诊所对手术候选人进行半结构化访谈，以及由专家小组进行审查。主要结局指标是做出白内障手术选择的主要属性。
等待时间、费用、机构声誉、外科医生经验和出行时间被确定为主要属性；对咨询时长和可及性的重视程度较低。非英语发言参与者表示比英语发言者对术前信息更感兴趣，但对澳大利亚医疗保健系统表示信任。
研究结果表明，个人在获得护理时会优先考虑那些消耗时间或产生费用的属性（等待时间、费用和出行时间）。他们还会考虑与白内障手术结果相关的因素（外科医生经验和机构声誉）。与其他决策过程类似，患者可能会根据个人偏好和情况在这些不同属性之间进行权衡。
