Views of older people on cataract surgery options: an assessment of preferences by conjoint analysis.

BACKGROUND: Key issues in the quality of care for people with cataracts in the UK include hospital waiting lists, complication rates from surgery, and the use of junior surgeons. The main objective of this study was to investigate the relative importance that older people attach to these factors when given theoretical choices over options for cataract surgery. METHOD: A systematic sample of 194 individuals aged 60-84 years on a general practice register in Nottingham were invited to take part in an interview based survey. Respondents ranked 11 "cataract surgery packages" containing different waiting list lengths, complication risks, and surgeon grades. Conjoint analysis was performed to determine the relative importance of these factors for individuals and for the group as a whole. RESULTS: Of the 194 subjects invited to participate, 146 (72%) completed the interview. For the group as a whole the "averaged importance" of the factors was: complication risk 45.8%; waiting time 41.1%, surgeon grade 13.1%. Analysis of importance scores for individuals showed that some were particularly concerned about complication risk while others were more concerned about waiting times. There was a strong negative correlation between importance scores for these factors (Spearman's rho -0.78, p<0.001). CONCLUSIONS: Most respondents thought that either risk of damage to sight and/or waiting time were important, while surgeon grade was relatively unimportant. The findings show that some potential cataract patients prefer a greater risk of complication combined with a short wait than a low complication rate and a longer wait.

The Role of Psychological Factors in Bariatric Surgery for Morbid Obesity: Identification of Psychological Predictors of Success.

This paper deals with two important questions in the Outcome of surgical treatment for morbid obesity. First, what is the impact of bariatric surgery on psychological functioning or quality of life? Second, and perhaps more important, can pre-surgical factors be identified that predict the outcome of surgery? These questions are answered by a systematic review of the current literature in this area. Throughout this paper the need for methodological rigor is stressed, and conclusions are based only on empirically sound findings. It is concluded that surgery is generally associated with improved psychological functioning and quality of life for most individuals. While a significant minority of morbidly obese individuals do not respond positively to surgery, there is no evidence to support the theory that obesity is a psychological defense mechanism, and therefore that bariatric surgery will produce widespread psychological problems. On a less positive note, while some studies identify pre-surgery psychological factors that predict weight loss following surgery, there has been no attempt to systematically replicate findings across studies, and no consistent findings have emerged from the literature. Due to the fact that the predictor variables examined have not been selected on theoretical grounds, the interpretation of isolated findings is difficult. On the basis of this review, however, distress over obesity appears to be a potentially important psychological predictor of the success of surgery. Unfortunately, there currently is no measure to specifically measure distress over obesity. What is needed at this time is a theoretically derived approach to the development of a scale to assess distress over obesity.