What doctors can do to address patients’ concerns
In a survey of 1,000 AARP members to assess patient perceptions of cataract surgery, three-quarters of post-op respondents reported a higher quality of life and said they wished they had had the surgery sooner. So why didn’t they? For the same reasons patients put off sinus surgery or other medical procedures: fear and anxiety.
At best, fears about surgery cause patients to avoid life-improving procedures. At worst, fear and anxiety put patients at risk for increased pain sensitivity and even death. Patients who experience uncontrolled hypertension in doctors’ offices—sometimes called “white coat syndrome”—are twice as likely to die of a heart attack or other cardiac event than patients whose blood pressure readings are always normal, according to medical news blog STAT.
What role do doctors and patient education play in managing patients’ fears and expectations?
The consequences of surgery-related fear and anxiety
Practicing ophthalmologists likely do not need a study to tell them that cataract surgery patients often experience fear and anxiety. However, studies confirm that anxiety is not only the most common negative effect associated with surgery, but also “a reliable predictor of postoperative mood and pain sensation,” noted an article in the journal Patient Education and Counseling.
Studies show that patients who report high levels of anxiety also experience higher levels of pain during and after surgery.
An Israeli study also found a correlation between anxiety and pain. As The Ophthalmologist reported, patients were asked to score their anxiety before and after cataract surgery on a scale of 1 to 10. While 65 percent of the patients experienced an expected level of pain, patients with severe anxiety (defined as higher than 7 on the scale) were more than 12 times more likely to experience severe pain after cataract surgery than those without.Patients with severe anxiety are more than 12 times more likely to experience severe pain after cataract surgery than those without. Click To Tweet
Other anxiety-induced complications noted in various studies include high blood pressure, reduced compliance during the procedure, and a higher rate of dissatisfaction afterwards.
Asking the right questions and setting expectations
Numerous studies as well as doctors’ own experiences and patients’ feedback show that patients’ satisfaction with surgical outcomes has as much to do with their expectations as with their objective results. Put simply, “Patients who understood their procedure and the surgical process were more satisfied with the result,” stated the journal Clinical Ophthalmology about the AARP study.
Addressing patients’ expectations impacts their satisfaction with surgical outcomes, yet many ophthalmologists fail to ask the right questions up front.
And yet there is evidence to suggest that there is a “blind spot” in many ophthalmologists’ approach, noted an article in the Journal of Clinical & Experimental Ophthalmology. “Although addressing patient expectations is perceived as an important part of patient-centered care, most ophthalmologists fail to routinely ask about patient expectations and, consequently, may not respond adequately.”
It starts with asking patients the right questions. With many IOL options, patients’ occupation and daily activities will drive their decision. Use specific examples and ask questions like, do you play golf and need to see from long distances? Are you an avid reader? Do you frequently drive at night? Also, find out whether patients are hoping the surgery will allow them to reduce dependence on glasses, or if they are willing to wear them for certain tasks. Their answers will inform your treatment recommendation, and help you assess the patient’s personality.
For more on this topic, see How to Manage Patients Unhappy with Cataract, Refractive Surgery Outcomes
Show them, don’t just tell them
When you start by asking patients questions, you may find that patient education is required to dispel some myths and fears. For instance, patients suffering from sinusitis may be hesitant to consider balloon sinuplasty if they don’t understand it and believe that it carries the same risks and side effects as other forms of sinus surgery such as adenoidectomy and functional endoscopic sinus surgery (FESS).
Videos can show patients what to expect from various surgical procedures and dispel any myths or misconceptions.
Show them this video to convey to them that balloon sinuplasty is safe, effective, and does not involve cutting bone or tissue within the nasal cavity. Also explain that the procedure can be performed in-office and with minimal recovery time, with many patients able to return to normal activities in one to two days.
As for cataract surgery patients, Rendia’s Outcome Simulator was designed to help doctors better communicate the value of advanced IOLs or the side effects of refractive surgery to their patients by showing them what their vision could look like after various procedures.
Patient education has been linked to a reduction in both anxiety and pain in patients. “Previous studies have shown the benefits of playing relaxing music and instructional videos in the waiting room, as well as holding the patient’s hand,” said researcher Michael Mimouni in The Ophthalmologist. It’s all about showing patients you understand and care about them and establishing an atmosphere of trust.