Schallhorn Steven C, Hannan Stephen J, Teenan David, Pelouskova Martina, Schallhorn Julie M
Department of Ophthalmology, University of California, San Francisco, CA, USA,
Optical Express, Glasgow, UK,
Clin Ophthalmol. 2018 Nov 29;12:2459-2470. doi: 10.2147/OPTH.S183249. eCollection 2018.
The aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion.
Patients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality.
Prior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (=0.47). In a multivariate model, the major predictor of patient's satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon's approach. The type of consent (remote or in-clinic) had no impact on patient's perception of consent quality in the regression model.
The majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient's perception of consent quality, regardless of the method of their consent.
本研究旨在比较采用远程医疗方法与外科医生进行术前同意讨论的屈光手术患者和进行面对面讨论的患者之间的同意过程质量。
回顾性分析2017年1月至12月期间接受治疗的患者（8184例激光视力矫正[LVC]患者和3754例屈光性晶状体置换[RLE]患者），这些患者参加了术后第1天和1个月的随访。术前同意准备包括与验光师会诊、观看教育视频和阅读书面信息。然后，患者根据自己的偏好选择与外科医生进行面对面预约（门诊组）或远程医疗预约（远程组）进行同意讨论。患者体验问卷和临床数据被纳入多变量模型，以探索与同意质量相关的因素。
手术前，80.1%的LVC患者和47.9%的RLE患者选择远程同意。在所有LVC患者中，97.5%的门诊患者和98.3%的远程患者表示他们已获得充分的手术同意（P=0.04）。RLE组中，门诊患者和远程患者的相应比例分别为97.6%和97.9%（P=0.47）。在多变量模型中，患者对同意过程满意度的主要预测因素是术后视力满意度，该因素解释了模型中80.4%的方差。其他重要因素包括术后视觉现象和干眼、夜间驾驶困难、近视力和远视力、术后未矫正远视力、矫正远视力变化以及对外科医生手术方式的满意度。同意类型（远程或门诊）在回归模型中对患者对同意质量的认知没有影响。
大多数患者选择远程医疗辅助同意。选择远程医疗的患者与与外科医生进行面对面交流的患者同样满意。无论同意方式如何，对手术结果的不满是影响患者对同意质量认知的主要因素。
