Development and Pilot Usefulness Testing of an Interactive Computerized Patient Decision Aid for Intraocular Lens Selection Before Cataract Surgery

Abstract

Chong-Bin Tsai,1,2 Chien-Liang Fang,3,4 Ming-Shan Chen,5,6 Min-Yueh Yen,1 Chi-Yen Yeh,7 Zhi-Ming Lai,7 Mei-Ling Hsu,7 Shan-Tair Wang8 1Department of Ophthalmology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; 2Department of Optometry, College of Medical and Health Science, Asia University, Taichung, Taiwan; 3Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; 4Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung City, Taiwan; 5Department of Anesthesiology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; 6Department of Biotechnology, Asia University, Taichung City, Taiwan; 7Department of Information Technology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; 8Department of Medical Research, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, TaiwanCorrespondence: Chong-Bin TsaiDepartment of Ophthalmology, Ditmanson Medical Foundation Chiayi Christian Hospital, No. 539 Zhongxiao Road, East District, Chiayi City, 60002, Taiwan, Tel [phone] ext 8503, Fax [phone], Email [email protected]: Modern cataract surgeries aim to treat impaired vision and also improve quality of life. An appropriate pre-operative selection of the intraocular lens is important to post-operative quality of life. Patients often have difficulty in choosing the best fit for individual needs. Patient decision aids (PDAs) are useful tools to assist patients in such decision-making process. However, most PDAs are paper-based and lack user interaction. This study is aimed to develop and evaluate an interactive computerized patient decision aid (cPDA) to help patients in the selection of an appropriate intraocular lens model before cataract surgery.Materials and Methods: Patients and their families who were making the decision regarding intraocular lens selection before cataract surgeries were eligible to participate in this study. A cPDA was built on an interactive robot, to help the patients in the decision-making process. The usefulness of the cPDA was measured with the Decision Self-Efficacy (DSE) scale and Preparation for Decision Making (PrepDM) scale.Results: A total of 50 participants (18 men and 32 women) were enrolled in the pilot test. The mean pre-cPDA DSE score was 46.5 ± 13.6, and the post-cPDA DSE score was 72.6 ± 12.8. The average gain score on DSE was 26.1, and the standard deviation was 8.0. The gain score on DSE was statistically significant, and the effect size was bigger than 3. The patients with junior or senior high degrees had the highest gain score on DSE, and the ones with college or above degrees had the lowest. The patients with college or above degrees had the highest PrepDM score, and the ones with elementary school or below had the lowest. Age and sex were not significant correlates of PrepDM. The patients with college or above degrees had the highest preparedness, but the lowest gain on DSE.Conclusion: Education levels are associated with the usefulness of cPDA, both for the preparedness and decision efficacy of patients. The results provide insight into the feasibility of cPDA for the decision-making of pre-operative intraocular lens selection.Keywords: decision making, preparedness, decision self-efficacy, education level

Keywords

• decision making
• preparedness
• decision self-efficacy
• education level