Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration
Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration
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DOI：
10.1080/13548506.2016.1274040
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发表时间：
2018-01-01
影响因子：
3.8
通讯作者：
Rees, Gwyneth
中科院分区：
文献类型：
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作者：
Boyle, Jessica;Vukicevic, Meri;Rees, Gwyneth
目前，减缓新生血管性年龄相关性黄斑变性 (AMD) 患者疾病进展的治疗方法需要定期玻璃体内注射抗血管内皮生长因子 (VEGF)，而且通常是无限期注射。人们对这种重复治疗方案给患者带来的负担以及如何最好地管理这一负担知之甚少。本研究的目的是探讨重复玻璃体内注射对新生血管性 AMD 患者的心理社会影响。从墨尔本一家私人眼科诊所和公立医院有目的地抽样，招募了 40 名接受抗 VEGF 治疗的新生血管性 AMD 患者（16 名男性，24 名女性）。使用黄斑疾病治疗满意度问卷（MacTSQ；布拉德利，英国萨里健康心理学研究单位）对患者进行调查，并接受半结构化、一对一的访谈。访谈主题为：治疗负担和满意度；耐受性；遵守的障碍；治疗动机；和患者教育。使用 NVivo 10（QSR International，唐卡斯特，澳大利亚）对访谈进行录音并进行主题分析。患者认识到治疗对保护视力的重要性，但治疗方案带来了巨大的心理社会和实际负担。重要问题包括与治疗相关的焦虑、财务考虑以及亲属或护理人员的交通负担。由于治疗副作用，许多患者在注射后只能进行久坐活动。患者优先考虑治疗，因为担心如果不接受治疗就会失去视力，因此常常牺牲家庭、旅行和社会承诺。虽然抗 VEGF 注射是目前新生血管性 AMD 的主要治疗方法，但正在进行的治疗方案给患者带来了巨大的负担。了解导致治疗负担的因素可能有助于制定减轻其影响的策略，并帮助患者更好地应对治疗挑战。
Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.