Preferences for participation in shared decision-making among cataract patients in urban southern China: a cross-sectional study

Abstract

BackgroundShared decision-making is known to facilitate quality care, but little research has been done to explore this issue in mainland China. This study aimed to assess the preferred and perceived involvement in decision-making among patients considering cataract surgery, which is the most commonly performed procedure worldwide. MethodsPatients awaiting cataract surgery were enrolled at a tertiary eye hospital in Guangzhou between May, 2015, and May, 2016, and completed a standardised interview. We measured preferred and perceived decision-making roles as reported by patients, and obtained information regarding their demographic characteristics, socioeconomic status, health literacy, and clinical data. The study database had no identifying information, and the ethics review committee of the Zhongshan Ophthalmic Center approved the consent procedure. All patients provided written informed consent. FindingsWe recruited 200 patients, of whom 182 completed the interview. 95 participants (52%) were men with a mean age of 71 years (range 21–90). 161 participants (88%) expressed a desire for engagement in shared decision-making (“mostly the doctor” n=57, “mostly me” n=44, and “doctor and me equally” n=60), whereas 21 (12%) preferred either little input from themselves or from the doctor. For 119 participants (65%) their perceived decision-making role matched their preferred role, whereas 44 (24%) preferred a more active role and 19 (11%) a more passive role. Preferring a more active role was significantly associated with adequate health literacy (odds ratio 3·6, 95% CI 1·5–7·3; p=0·004), but not with gender, education level, visual acuity, and severity of lens opacity. InterpretationNew strategies promoting health literacy could improve patients' involvement in decision-making, which might increase patient satisfaction and reduce demand for specialised eye care. FundingNational Natural Science Foundation of China (81200685); National Natural Science Foundation of China (81100686); Science and Technology Program of Guangzhou, China (15570001); and Fundamental Research Funds of the State Key Laboratory of Ophthalmology.