Doctor-patient communication key in glaucoma treatment

Fort Lauderdale, FL-Most patients with glaucoma do not seek out another specialist for their care, however, when they do it is most likely due to poor communication, according to a recent Glaucoma Research Foundation (GRF) survey.

The results of the Allergan Inc.-supported survey were presented at the recent annual meeting of the Association for Re- search in Vision and Ophthalmology.

"We know that doctor-patient communication is a key determinant of patient satisfaction," noted GRF President and CEO Thomas M. Brunner. "Research has shown that communication problems make up the lion's share of patient complaints about doctors, rather than complaints about the doctor's skill."

Brunner echoed the findings of other researchers, noting that the beneficent model of communication works well for resource-limited, managed-care environments and may be appropriate for those patients who automatically accept their physicians' treatment decisions without question.

"We also know, however, that patient-centered communication correlates with better emotional health and fewer tests and referrals," Brunner continued. "Early consumer activism, and later, Internet-based health information, have sparked a trend in patient-centered communication in healthcare."

Complicated communications The fact that most glaucoma patients are asymptomatic until the late stages of the disease can complicate doctor-patient communications because patients may not internalize the importance of compliance.

"Another potential reason for communication compromise is the Internet," said Brunner. "According to a 2002 SeniorNet survey, 72% of seniors use the Internet to find health information. The problem is, if one does a Google search for 'glaucoma,' one gets thousands upon thousands of hits. How much of this information is good information is largely unknown. Seniors, who process information more slowly anyway, are subject to a wide variety of truths and half-truths about their disease."

The survey The purpose of the GRF Patient Survey was to identify patterns of doctor-patient communication in a population of U.S. patients with glaucoma and to assess the impact that such communication may have on patient behavior.

Some 22,000 GRF newsletter subscribers were invited to complete a questionnaire. The questions involved patient knowledge about glaucoma, relationship with current physician, and attitude toward medication side effects.

Responses were received from 4,310 glaucoma patients. The majority of respondents were female (69%) and older than 72 years (51%). Also, most respondents (78%) had glaucoma diagnosed at least 5 years prior to participating in the survey.

Side effects By far, most patients surveyed (92%) considered efficacy of medication to be more important than possible side effects. A full 87% of patients said they would continue to comply with their prescribed medication even if they experienced hyperemia or iris pigmentation, and the majority of respondents (85% to 89%) were rarely or never disturbed by red eyes or iris color change.

Seventy-two percent of patients reported that they never changed their ophthalmologist. But 60% of those who did switch reported they sought out a different doctor because they were dissatisfied with the level of communication.

The survey researchers concluded from patient responses that the majority of physicians (54%) communicate in a patient-centered manner and provide adequate explan- ations of glaucoma, the necessary therapy, and the potential long-term risks to vision.

About 42% of physicians communicate with their patients in a beneficent manner. Some 31% of these physicians assured patients that they would be fine if they were consistent with the use of their drops. Also, these patients were not warned about the potential risk of visual loss and its impact on the quality of life, nor were they told about the importance of compliance with medication and keeping scheduled appointments. About 11% of these respondents said their doctor didn't relay much information about glaucoma at all.