Investigation of attributes which guide choice in cataract surgery services in urban Sydney, Australia

Clin Exp Optom. 2018 May;101(3):363-371. doi: 10.1111/cxo.12653. Epub 2018 Jan 17.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: cataract; discrete choice experiment; patient preferences; patient-centred care.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cataract Extraction / standards*
  • Decision Making*
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • New South Wales
  • Ophthalmology / standards*
  • Practice Guidelines as Topic*
  • Qualitative Research
  • Referral and Consultation
  • Review Literature as Topic
  • Urban Population*