Italian group probes refractive surgery patient opinions

Bescia, Italy-A patient questionnaire about their experience with refractive surgery is in the process of development by the Italian Refractive Surgery Society. The preliminary results reported by Elena Scaffidi, Psych MA, indicate that the questionnaire was well perceived by patients and provided a great deal of input for improving their experience.

"Quality of life depends on medical and psychological factors, and satisfaction with care relies on the different features of the health care received. Health-care managers have long been accustomed to patient satisfaction assessments; however, in contrast, clinicians are more familiar with subjective measures of quality of life," she said.

"[Managers are] is especially concerned with ensuring a good level of health care and use patient satisfaction data as a marketing tool. Clinicians, however, are interested in evaluating the effectiveness of therapies and surgical treatments supplying quality-of-life data. Surgeons only recently have found valuable data in assessments of patient satisfaction. This variable can be viewed as a significant determinant of quality of life," said Dr. Scaffidi, who is a clinical psychologist and psychotherapist and head of the psychology unit of the Istituto Laser Microchirurgia Oculare, Brescia, Italy.

"In this sense, refractive surgery is a unique field because there is almost universal acknowledgement that a patient with only a visual defect cannot be considered ill. On the other hand, it is no longer controversial that some individuals can perceive themselves as highly affected by a visual impairment and/or functionally, esthetically, behaviorally, and psychologically [affected]," she pointed out.

Patient satisfaction in the context of refractive surgery is a fairly new concept in Italy. The Italian Refractive Surgery Society carried out this study to achieve a better understanding of the variables that result in patient satisfaction. It developed a questionnaire to be used in a variety of ophthalmic settings, Dr. Scaffidi explained.

"One of the goals of the society was to emphasize the importance among ophthalmologists of the doctor-patient relationship as an essential tool to comprehend both the patient's visual problems and the person as a whole, and to orient the physician better to decision-making when selecting the surgical technique," she said.

The prospective study began in September 2005.

To determine which factors should be included in the questionnaire, focus groups of psychologists, patients who were to undergo refractive surgery, and those who had undergone refractive surgery were held.

From September 2005 to February 2006, a sample of 103 patients was asked to fill out a 35-item questionnaire during the first month after their surgery. The first group of patients to respond comprised 21 patients who provided suggestions and comments to improve the questionnaire. The second group of 21 patients responded to the new changes added to the questionnaire. Analysis of the preliminary results was done of the remaining sample of 61 patients.

"The instrument allows the patient to provide feedback to researchers on the feasibility of assessment, the appropriateness of contents, and clarity of the wording. The choice of topics to be evaluated, phrasing, and wording of the items, understanding, and appropriateness of the questions seem to have been viewed positively by the group of patients evaluating the questionnaire. The instrument was well perceived by patients both in terms of the adequacy, meant as appropriateness to assess satisfaction, and also to the attention paid to their needs and ideas," Dr. Scaffidi reported.

"To assess patient satisfaction concerning refractive surgery, the validated questionnaire is a very good tool to enhance patient education, to permit the surgeon to evaluate the surgical techniques, to monitor individual clinical situations, and to implement communication within the doctor-patient relationship. Further study will confirm the validity of the results. The sample size will be increased to provide power to reach significance and interpret the data more precisely ," Dr. Scaffidi concluded.