PATIENT-REPORTED OUTCOMES IN CATARACT SURGERY: BEYOND VISION AND EXPLORING THE PATIENT PATHWAY EXPERIENCE

Patient-centred care is a healthcare model that coordinates compassionate care with the patient at the centre of all healthcare decisions. This approach is facilitated through listening to the patient’s narrative, which can be captured using patient-reported outcome measures (PROMs). PROMs have become increasingly useful in modern healthcare practice for quantifying the subjective experiences of patients, comparing between healthcare interventions, and assessing the quality of care. Despite the ability of PROMs to drive changes in how healthcare is organised and delivered, popular cataract-related PROMs only examine visual function. Our study objectives were to create a PROM for the patient pathway experience and to trial it in our regional cataract pathway.

A single-centre questionnaire-based study in the Ophthalmology Department at North Middlesex University Hospital NHS Trust (London, United Kingdom) was conducted between 1st January 2024 and 31st March 2024.

An internally-validated PROM questionnaire was designed using a comprehensive literature review and feedback from ophthalmic colleagues. The questionnaire collected basic demographic data, assessed subjective visual function and captured the patient experience in the cataract pathway. The cataract pathway was defined from initial community referral to final postoperative assessment. Questionnaire data was reported using descriptive statistics and analysed using non-parametric correlations.

253 cataract operations and 140 anonymous questionnaires were collected over 3-months. The mean (SD) patient age was 71.3 (12.2) with a mean (SD) BCVA gain following cataract surgery of +0.33 (0.57) LogMAR. Mean (range) referral time to initial cataract appointment was 51.2 (1–365) days. Our cohort were satisfied with the referral time to surgery (136/140, 97.1%) and the consenting process (127/137, 92.7%). Majority of patients reported a significant improvement in postoperative vision (112/137, 81.8%). Mean (SD) postoperative satisfaction was 4.18 (1.25) out of 5.00 following cataract surgery. The top reported side-effects were grittiness (27/103, 26.2%), itchiness (21/103, 20.4%) and pain (18/103, 17.5%). There was a weak negative linear correlation between patient satisfaction and number of postoperative side-effects (r = -0.210, P<0.05), and a weak positive linear correlation between patient satisfaction and BCVA gain (r = +0.120, P=0.16).

Integrating PROMs into routine care can deliver on high-quality clinical outcomes and contribute to the gold standard in good ophthalmic practice. Our study demonstrates the rich feedback that can be collected from a PROM capturing the patient pathway experience, which can be used to improve cataract service delivery. New PROMs should look beyond an assessment of visual function alone, but also examine the patient pathway experience.