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Editors Selection IGR 18-3
General aspects: Quality of life
Comment by Anja Tuulonen on:
11730 Patient expectations regarding eye care: development and results of the Eye Care Expectations Survey (ECES), Dawn AG; McGwin G Jr; Lee PP, Archives of Ophthalmology, 2005; 123: 534-541
Dawn et al. (376) developed a tool for better understanding patients' expectations regarding eye care. The instrument was developed through literature review and focus group interviews. Two hundred and two patients of four eye practices around Duke University Eye Center completed the pilot version of the Eye Care Expectations Survey (ECES). Eye patients had four types of expectations: 1. Patient involvement in eye care; 2. Interpersonal manner; 3.
Information about diagnosis and prognosis; and 4. Communication and clinical competence. These factors explained 89% of the total variance. The expectations were influenced by the severity of the eye disease, the patient's conception of vision, best corrected visual acuity, sex, education, race, and household income. The authors concluded that based on this cross-sectional study, the 27-item ECES appears to be a useful tool to improve patient-centered eye care. The authors should be congratulated for their systematic approach and initiative to enlighten the hitherto nearly unexplored patient expectations in eye care and the emphasis on the evaluation and improvement of clinical practices. It is important to develop new decision support tools and develop not only the skills of physicians but also culture and structures within the eye health care systems including research. The latter means that we have to become accustomed and able to evaluate also qualitative research tools, which so far may have been considered strange or less accurate in medicine. The results of the study indicate that promotion of patient-oriented decision making and communication skills are important in eye care. The way of communicating and reporting results affects not only physicians' but also patients' decisions. In addition to patient involvement in decision-making, 'soft' aspects in care such as personal interaction and caring - often regarded as self-evident by professionals - appeared to be significant in the survey. Patient involvement in eye care and interpersonal manner accounted for 72 % of the variance. The fact that information about diagnostics and prognosis explained only 10 % of the variance may be a reflection for the fact that 96 % of patients in the academic eye center had visited an eye doctor previously and thus may have already received the desired information earlier. In addition, 59% of the participants were seen for routine or refractive eye problems, 61 % of patients were female, and 74 % white. Whether the results will be similar in non-academic centers, less routine cases and different ethnic groups requires further research. We now have a tool to study these aspects and to improve both the tool and our clinical practices with further research.
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