Informed consent in refractive surgery: in-person vs telemedicine approach
Informed consent in refractive surgery: in-person vs telemedicine approach
复制标题
DOI：
10.2147/opth.s183249
复制
发表时间：
2018-01-01
影响因子：
2.2
通讯作者：
Schallhorn, Julie M.
中科院分区：
文献类型：
--
作者：
Schallhorn, Steven C.;Hannan, Stephen J.;Schallhorn, Julie M.
目的：本研究的目的是比较术前使用替仑西辛方法与外科医生进行同意讨论的患者和进行面对面讨论的患者之间屈光手术同意过程的质量。方法：对 2017 年 1 月至 12 月期间接受治疗的患者（8,184 例激光视力矫正 [LVC] 和 3,754 例屈光晶状体置换 [RLE] 患者）进行术后第 1 天和 1 个月就诊的回顾性评估。术前同意书准备包括咨询验光师、观看教育视频和书面信息。然后，患者根据自己的喜好选择与外科医生面对面预约（诊所组）或远程医疗预约（远程组）进行同意讨论。将患者体验问卷和临床数据纳入多变量模型，以探讨与同意质量相关的因素。结果：手术前，80.1% 的 LVC 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% 的远程患者表示充分同意手术（P=0.04）。 RLE 组中临床患者的相似百分比为 97.6%，远程患者为 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，该模型解释了 80.4% 的方差。其他重要的影响因素包括术后视觉现象和干眼、夜间驾驶困难、近距离和远视力、术后未矫正远视力、矫正远视力的变化以及对外科医生方法的满意度。在回归模型中，同意类型（远程或诊所）对患者对同意质量的看法没有影响。结论：大多数患者选择了远程医疗辅助同意。选择它的人与与外科医生进行面对面会面的人同样满意。无论患者同意的方式如何，对手术结果的不满意是影响患者对同意质量看法的主要因素。
Purpose: 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 telensedicine approach and those who had a face-to-face discussion.Methods: 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.Results: 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 (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=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 inclinic) had no impact on patient's perception of consent quality in the regression model.Conclusion: 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.