Informed consent in refractive surgery: in-person vs telemedicine approach

Abstract

PurposeThe aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion.MethodsPatients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality.ResultsPrior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=0.47). In a multivariate model, the major predictor of patient’s satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon’s approach. The type of consent (remote or in-clinic) had no impact on patient’s perception of consent quality in the regression model.ConclusionThe majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient’s perception of consent quality, regardless of the method of their consent.

A Preliminary Study Investigating Patients’ Perceptions of Research Consenting Methods

“…This model has been used to evaluate physicians' acceptance of telemedicine technology (Hu, Chau, Sheng, & Tam, 1999), but no studies have used this model to evaluate teleconsent technologies. Studies previously evaluating patient's perceptions of telemedicine approach to consent versus paper-based consent reported that patients preferred the telemedicine approach (Schallhorn, Hannan, Teenan, Pelouskova, & Schallhorn, 2018). Several methods have been developed to investigate patient and provider perception of various consent forms (Chalil Madathil et al, 2013;Khasawneh, Rogers, Bertrand, Madathil, & Gramopadhye, 2019;Welch et al, 2016) that will be used to perform this study.…”

Assessment of the Quality and Reliability of YouTube Videos on Fuch’s Endothelial Corneal Dystrophy

“…Patients who want to take a more active role in decision-making about their treatment are increasingly using the internet to seek information about their disease [8]. Achieving the right information from reliable sources increases patient satisfaction and can improve treatment results [9][10][11]. However, in our assessment of the quality of information presented in YouTube videos on FECD, we found that these videos provided only moderate-quality information about the disease.…”

Transepithelial photorefractive keratectomy on the same day of the initial consultation for the correction of myopia

“…Promising results of patient satisfaction with remote consenting for elective refractive surgery have been shown. 18 In addition, our previous experience with femtosecond laser assisted in situ keratomileusis (FS-LASIK) on the day of the first screening visit has affirmed the results of this procedure. 19 However, scant data are available regarding the clinical outcomes of Trans-PRK surgery completed during the day of the first consultation appointment in compared with a following visit.…”