Alisa Sivak, MA(Ed), is Managing Editor of Contact Lens Update and Head of Knowledge Translation at the Centre for Contact Lens Research, in the School of Optometry and Vision Science at the University of Waterloo.
Balancing the substantial cost of practice overheads with the time it takes to explain a diagnosis and its management to a patient is a tricky juggling act. On one side, your time is money: get the patients in, examine and diagnose them, send them home with a prescription or instructions for home treatment; on the other side, the eye care field’s increasing understanding of ocular physiology, dysfunction and the drive to share what we know with patients.
An issue that’s not unique to the field of eye care
The extent to which health care professionals communicate with their patients is a hot topic amongst other health-related fields too, with a wide body of literature around concepts such as “patient empowerment”1, 2 and “patient-centeredness.”3, 4 Studies in these areas report that patients want more information about their conditions than health care professionals think.5-11 Topics of interest identified by patients include the causes, consequences and prevalence of conditions,8 what medications are meant to do5, 6 as well as their side effects,5, 6, 10 and the ways in which one might need to adapt one’s lifestyle during treatment.5-7 Could it be that health professionals underestimate patients’ desire for – and ability to cope with – information?8
Concerns about non-compliance12-19 have grown in the eye care field in recent years, but what is the solution? While some research has suggested that providing patients with more information makes no difference or has negative effects on patient education,20-22 and other research has explored the role of patients’ communication style and literacy, personal characteristics and demographics when it comes to receiving information23-26 Holmstrom1 and others27,28 have suggested that patients who are active in understanding their condition will manage self-care more effectively. Positive results have been reported in the fields of hypertension,11, 29 cancer,30, 31 diabetes,32 oral health,26 hormone replacement therapy33 and eczema34 among others. Edwards et al.8 reported that participants with a variety of health conditions were better able to understand how to manage their condition if they understood it, in addition to the ways in which their medications and treatments work.
Communicating with patients about eyelid conditions
The 2011 release of the Tear Film and Ocular Surface Society’s report on meibomian gland dysfunction (MGD) has provided inspiration for a focus on eyelid conditions, some of which we have focused on in this and other editions of Contact Lens Update.
- New techniques and technology help us visualize and treat MGD
- How MGD affects contact lens wear
- Demodex is more prevalent than we thought
- We are getting better at differentiating between Demodex and blepharitis
This is great news for patients, but has it had an impact on the ways in which eye care professionals communicate this information?
Unlike many of the conditions affecting ocular health, conditions associated with the eyelids are a little bit more accessible to the average lay person. While conditions affecting vision often rely on an understanding of fairly advanced concepts, patients will have a superficial understanding of topics like “blocked glands”, “crusty eyelids” and even a squeamish response to the thought of parasitic mites living amongst their eyelashes. They might have identified related symptoms and will likely need to play an active role in the management of these conditions.
Given this accessibility in understanding, we’re curious: How do you decide how much information to share with your patients, and what goes into that decision?
Patient handout: meibomian gland dysfunction
As vision science researchers with experience of what happens in clinical practice, we understand that the days of an eye care professional are incredibly busy, and we want to help – by keeping you up-to-date on the latest research and by providing you with the tools to help you communicate some of those details with patients.
We developed our MGD handout with significant input from the Tear Film & Ocular Surface Society, using its 2011 Report on Meibomian Gland Dysfunction as a guideline and distilling the information into language we believe will speak directly to the average lay person who has been diagnosed with MGD. We designed it to be a reference they can take home with them. It touches on the significance of meibomian glands with respect to maintaining ocular comfort and health, the ways in which these glands might have become problematic, and provides a checklist for busy ECPs to use in outlining the most appropriate home-based treatment.
We want to hear from you!
While we at the CCLR are passionate about developing information for patients, we know that eye care professionals in practice have significant insights when it comes to patient needs and expectations. We would appreciate it if you could take five minutes to provide some input that will help to shape future handouts. Thank you!
- Holmstrom I, Roing M. The relation between patient-centeredness and patient empowerment: a discussion on concepts. Patient Educ Couns 2010;79:167-172.
- Anderson RM, Funnell MM. Patient empowerment: myths and misconceptions. Patient Educ Couns 2010;79:277-282.
- Saha S, Beach MC. The impact of patient-centered communication on patients’ decision making and evaluations of physicians: A randomized study using video vignettes. Patient Educ Couns 2011;84:386-392.
- Zimmermann L, Konrad A, Muller C, Rundel M, Korner M. Patient perspectives of patient-centeredness in medical rehabilitation. Patient Educ Couns 2014;96:98-105.
- Berry D, Gillie T, Banbury S. What do patients want to know: An empirical approach to explanation generation and validation. Expert Systems with Applications 1995;8:419-429.
- Dickinson D, Raynor DK. What information do patients need about medicines? Ask the patients–they may want to know more than you think. Bmj 2003;327:861.
- Berry DC, IR M, T G, M F. What do patients want to know about their medicines, and what do doctors want to tell them? : A comparative study. Psychology and Health 1997;12:467-480.
- Coulter A, Entwistle V, Gilbert D. Sharing decisions with patients: is the information good enough? Bmj 1999;318:318-322.
- Raynor DK, Savage I, Knapp P, Henley J. We are the experts: people with asthma talk about their medicine information needs. Patient Educ Couns 2004;53:167-174.
- Bowden FW, 3rd, Cohen EJ, Arentsen JJ, Laibson PR. Patterns of lens care practices and lens product contamination in contact lens associated microbial keratitis. CLAO J 1989;15:49-54.
- Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? Jama 1984;252:2990-2994.
- Dumbleton K, Richter D, Woods C, Jones L, Fonn D. Compliance with contact lens replacement in Canada and the United States. Optometry and vision science : official publication of the American Academy of Optometry 2010;87:131-139.
- McMonnies CW. Hand hygiene prior to contact lens handling is problematical. Contact lens & anterior eye : the journal of the British Contact Lens Association 2012;35:65-70.
- Robertson DM, Cavanagh HD. Non-compliance with contact lens wear and care practices: a comparative analysis. Optometry and vision science : official publication of the American Academy of Optometry 2011;88:1402-1408.
- Jansen ME, Chalmers R, Mitchell GL, et al. Characterization of patients who report compliant and non-compliant overnight wear of soft contact lenses. Contact lens & anterior eye : the journal of the British Contact Lens Association 2011;34:229-235.
- Carnt N, Keay L, Willcox M, Evans V, Stapleton F. Higher risk taking propensity of contact lens wearers is associated with less compliance. Contact lens & anterior eye : the journal of the British Contact Lens Association 2011;34:202-206.
- Morgan PB, Efron N, Toshida H, Nichols JJ. An international analysis of contact lens compliance. Contact lens & anterior eye : the journal of the British Contact Lens Association 2011;34:223-228.
- Hickson-Curran S, Chalmers RL, Riley C. Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Contact lens & anterior eye : the journal of the British Contact Lens Association 2011;34:207-215.
- Jones L, Dumbleton K. Comfort and compliance with frequent replacement soft contact lenses. Optometry and vision science : official publication of the American Academy of Optometry 2002;79:259.
- Lamb G, Heron J, Green S. Can Physicians Warn Patients of Potential Side-Effects without Fear of Causing Those Side-Effects. Clin Res 1991;39:A627-A627.
- Myers ED, Calvert EJ. The effect of forewarning on the occurrence of side-effects and discontinuance of medication in patients on amitriptyline. The British journal of psychiatry : the journal of mental science 1973;122:461-464.
- Howland JS, Baker MG, Poe T. Does Patient Education Cause Side-Effects – a Controlled Trial. J Fam Practice 1990;31:62-64.
- Street RL, Jr. Information-giving in medical consultations: the influence of patients’ communicative styles and personal characteristics. Social science & medicine 1991;32:541-548.
- Say R, Murtagh M, Thomson R. Patients’ preference for involvement in medical decision making: a narrative review. Patient Educ Couns 2006;60:102-114.
- Jordana J, Buchbinder R, Osborne R. Conceptualising health literacy from the patient perspective. Health Literacy and Communication 2010;79:36-42.
- McQuistan MR, Qasim A, Shao C, Straub-Morarend CL, Macek MD. Oral health knowledge among elderly patients. Journal of the American Dental Association 2015;146:17-26.
- Coulter A. Paternalism or partnership? Patients have grown up-and there’s no going back. Bmj 1999;319:719-720.
- Dowell J, Hudson H. A qualitative study of medication-taking behaviour in primary care. Family practice 1997;14:369-375.
- England SL, Evans J. Patients Choices and Perceptions after an Invitation to Participate in Treatment Decisions. Social science & medicine 1992;34:1217-1225.
- Bates AK, Morris RJ, Stapleton F, Minassian D, Dart J. ‘Sterile’ corneal infiltrates in contact lens wearers. Eye 1989;3:803-810.
- Zeguers M, de Haes HC, Zandbelt LC, et al. The information needs of new radiotherapy patients: how to measure? Do they want to know everything? And if not, why? International journal of radiation oncology, biology, physics 2012;82:418-424.
- Kaplan SH, Greenfield S, Ware JE, Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical care 1989;27:S110-127.
- Connelly MT, Ferrari N, Hagen N, Inui TS. Patient-identified needs for hormone replacement therapy counseling: a qualitative study. Annals of internal medicine 1999;131:265-268.
- Thompson DL, Thompson MJ. Knowledge, instruction and behavioural change: building a framework for effective eczema education in clinical practice. Journal of advanced nursing 2014;70:2483-2494.