Patients' preferences for involvement in the decision-making process for treating diabetic retinopathy.

BACKGROUND: To assess factors associated with the preferred role of the attending ophthalmologist in the decision-making processes before treating diabetic retinopathy (DR). METHODS: Cross-sectional study of 810 adults attending secondary diabetes care centers (NCT02311504). Diabetes patients were classified using a validated questionnaire in an ophthalmologist-dominant decision-making (ODM), shared decision-making (SDM) and patient-dominant decision-making (PDM) style. Multivariate logistic regression was performed to determine factors associated with the decision-making process. RESULTS: A majority of 74.3% patients preferred SDM between ophthalmologist and patient, 17.4% patients wanted ODM, delegating the decision-making process to the ophthalmologist, 8.3% preferred the autonomous style of PDM. Patients wanting ODM were older (OR = 1.2 per decade, p = 0.013), had a lower level of education (OR = 1.4, p = 0.001) and had a higher frequency of consultations per year (OR = 1.3, p = 0.022). Patients with better basic knowledge in DR and memorizing their HbA1c level showed a higher propensity for SDM (OR = 1.1, p = 0.037). Patients wanting PDM had a significantly higher education (OR = 1.3, p = 0.036) and a greater desire for receiving information from self-help groups (OR = 1.3, p = 0.015). CONCLUSIONS: The first evaluation of the general patient wishes for the treatment of DR confirmed the concept of SDM, which was favored by three quarters. In particular, older patients with low educational attainment wanted to delegate the decision-making process to the ophthalmologist. Amelioration of ophthalmologic education in diabetic programs might take up patients' propensity for SDM. Regardless of the decision-making group, nearly all patients wanted the medical and scientific information to be transferred by and shared with the ophthalmologist. TRIAL REGISTRATION: The study was registered on www.clinicaltrials.gov (identifier: NCT02311504) on December 4th 2014.

Limited Time from the Diabetes Patients' Perspective: Need for Conversation with the Eye Specialist.

PURPOSE: Facing the lack of time, busy retina consultants should be aware of how the patients would prefer that time is spent and whether they wish the specialist to talk more at the expense of other medical activities. METHODS: 810 persons with diabetes were asked to divide the time of 10 min between examination, consultation and treatment when envisioning a real-life scenario of diabetic retinopathy (NCT02311504). RESULTS: With the increasing duration of diabetes, patients wanted significantly more time for diagnostics (p = 0.028), while age was found to be associated with less time for treatment (p = 0.009). Female subjects tended to prefer only little more time for talking (p = 0.051) in comparison with males, who slightly favored therapy (p = 0.025). CONCLUSIONS: The large majority recognized the need for diagnostics in their allocation of time. If individual patients are confronted with the health care perspective of time constraints, this might improve the understanding of prioritization.

[Interdisciplinary communication: ophthalmologists' letters to practices specializing in diabetic patients]. / Interdisziplinäre Kommunikation: Augenarztbriefe an diabetologische Schwerpunktpraxen (DSP).

BACKGROUND: Ophthalmologists' letters and medical reports play an important role in the interdisciplinary cooperation between general practitioner, internist, diabetologist and ophthalmologist providing means of information and communication for the avoidance, delay and treatment of diabetic retinopathy (DR). METHODS: In a cross-sectional study (NCT02311504) the ophthalmologicsts' letters and other clinical parameters were extracted from electronic patient records (EPR) of 810 patients with diabetes. Files were classified into different categories of formats, tested with respect to topicality and content structure and analyzed according to the topic complex of the national treatment guidelines for retinal complications. RESULTS: In 59% of the patients an ophthalmologist's medical report was identified in the EPR. Of these, 26% were computer-generated documents, 73% were handwritten. 55% used the standard form of the national guidelines, 21% were self-designed formats, 16% detailed letters, 5% short reports and 3% short messages. The information was written on average 19 months ago. Of the documents 25% were older than 2 years at the time of the study. Of the patients 75% visited an ophthalmologist in the previous 12 months, yielding a report rate of only 40%. The prevalence of DR reported in the forms was 12%, in detailed letters 32%. CONCLUSION: Although standardized forms are widely distributed in the ophthalmologists' communication with diabetologists, there is room for improvement in the face of the low report rate to enable a timely consideration of relevant findings. The high number of handwritten documents shows the large untapped potential of electronic formats in the interdisciplinary communication.