title: The Effect of Counseling on Cataract Patient Knowledge, Decisional Conflict, and Satisfaction.
abstract: OBJECTIVE
  Cataract is the leading cause of non-refractive preventable blindness, and comprehensive strategies to increase cataract surgery rates are imperative, including high-quality supportive patient education. We evaluated the effectiveness of non-physician pre-surgical counselors teaching patients about cataract and cataract surgery in improving patient knowledge, decisional conflict, and satisfaction.
  
  
  METHODS
  A survey was given before and after 61 newly-diagnosed cataract patients underwent pre-surgical counseling at the Aravind Eye Hospital, Madurai, India. The survey measured change in cataract knowledge and decisional conflict, a measure of anxiety surrounding the decision to undergo surgery, along with patient satisfaction. Multiple regression was used to identify factors that influenced change in knowledge.
  
  
  RESULTS
  Both patient knowledge scores and decisional conflict scores improved following counseling (mean difference +2.0, p = 0.004 and +8.4, p < 0.0001, respectively). Multiple regression analysis identified female sex (β = 2.5, p < 0.001) and being illiterate (β = 1.7, p = 0.04) as important predictors of increased knowledge post-counseling.
  
  
  CONCLUSIONS
  Counseling both improved knowledge and reduced decisional conflict about cataract surgery, particularly among patients who had traditionally had more limited access to healthcare such as women and illiterate patients. Increased use of high quality counseling might help to further reduce the global burden of cataract and other forms of blindness.
authors.affiliation: a Department of Ophthalmology and Visual Sciences , University of Michigan , Ann Arbor , MI , USA .
authors.forename: Paula Anne
authors.initials: PA
authors.lastname: Newman-Casey
authors.affiliation: b Aravind Eye Care System , Madurai , India .
authors.forename: Sathya
authors.initials: S
authors.lastname: Ravilla
authors.affiliation: b Aravind Eye Care System , Madurai , India .
authors.forename: Aravind
authors.initials: A
authors.lastname: Haripriya
authors.affiliation: c Lions Aravind Institute of Community Ophthalmology , Madurai , India .
authors.forename: Vinoth
authors.initials: V
authors.lastname: Palanichamy
authors.affiliation: b Aravind Eye Care System , Madurai , India .
authors.forename: Manju
authors.initials: M
authors.lastname: Pillai
authors.affiliation: c Lions Aravind Institute of Community Ophthalmology , Madurai , India .
authors.forename: Vijayakumar
authors.initials: V
authors.lastname: Balakrishnan
authors.affiliation: a Department of Ophthalmology and Visual Sciences , University of Michigan , Ann Arbor , MI , USA .|d Departments of International Health and Ophthalmology , Johns Hopkins University , Baltimore , MD , USA , and.|e Department of Ophthalmology , University of Maryland , Baltimore , MD , USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Robin
mesh_terms: D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D002386:Cataract; D002387:Cataract Extraction; D003376:Counseling / Q000379:methods*; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cataract surgical rate; counseling; education; epidemiology of blindness; international ophthalmology; workforce