Meaningful Patient Partnerships: A Qualitative Study of Patient Perspectives and Shared Decision-Making Regarding Glaucoma Surgery.

Abstract

Purpose: Patient-centered care is key to successful clinical outcomes and meaningful clinician-patient relationships. Accordingly, a comprehensive understanding of patient perspectives is essential to aligning the clinician's focus and patient's goals. However, our understanding of patients' perceptions of glaucoma surgery and involvement in surgical decision-making has not kept pace with the rapid treatment advances in the field and move toward earlier surgery with the advent of minimally invasive glaucoma surgery devices. The purpose of this study was to understand the perspectives and priorities of people with glaucoma when considering glaucoma surgery through qualitative analysis of semistructured interviews.

Design: A qualitative study.

Participants: Individuals diagnosed with glaucoma, above 18 years of age, and able to communicate effectively in English. Interviews were conducted with 40 participants: 23 participants who had undergone glaucoma surgery and 17 who had not.

Methods: Interviews were conducted over telephone, using an interview guide developed in consultation with people with glaucoma and surgeons. The cohort was purposely sampled to ensure representation across age, sex, socioeconomic status, remoteness, glaucoma severity, clinic settings, and treatment histories. Transcripts were iteratively analyzed to identify key themes pertaining to perceptions of glaucoma surgery and involvement in decision-making.

Main outcome measures: Surgical perception and involvement themes, including barriers and bridges to confidence in glaucoma surgery.

Results: Six key themes were identified: (1) patients feeling rushed; (2) onus on the patient to seek information; (3) undercurrents of anxiety; (4) perceptions of surgery shaped by understanding and expectations of the disease and its treatment paradigm; (5) trust in surgeon imbuing confidence in surgery; and (6) empowerment through understanding of alternatives. Key barriers to patient involvement included patient anxiety, time pressures (real or perceived), and perceived urgency of intervention.

Conclusions: Shared decision-making in glaucoma surgery remains aspirational. This study provides valuable insights into patient perceptions of glaucoma surgery, which can help inform patient-centered care. Readily applicable "practice points" are proposed to optimize patient involvement and empowerment.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.