CORRESPONDENCE
159
Figure 1. Top left: The corrected distance visual acuity (CDVA) achieved in this series (red) compared with CDVA achieved by other EUREQUO surgeons across Europe (green). Top right: Biometry prediction error, percentage within 1.0 diopter deviation from intended achieved in this series (red) compared with biometry prediction error achieved by other EUREQUO surgeons across Europe (green). Bottom left: Capsule complication rate (%) in this series (red) compared with capsule complication rate of other EUREQUO surgeons across Europe (green). Bottom right: Biometry prediction error in this series (red) compared with biometry prediction error of other EUREQUO surgeons across Europe (green). supervision provided by accredited training posts. Surgeon 2011; 9(suppl 1):S14–S15 4. Watters DAK, Green AJ, van Rij A. Requirements for trainee logbooks. ANZ J Surg 2006; 76:181–184 5. Watters DAK, Green AJ, van Rij A. Guidelines for surgical audit in Australia and New Zealand. ANZ J Surg 2006; 76:78–83
OTHER CITED MATERIAL A. Royal College of Ophthalmologists. Logbook. London, UK. The Royal College of Ophthalmologists, 2011. Available at: http://www.rcophth.ac.uk/page.asp?sectionZ152§ionTitleZLogbook. Accessed September 23, 2013 B. Royal College of Surgeons Edinburgh. The Pan-Surgical Electronic Logbook for the United Kingdom & Ireland - A log book for life. Available at: https://www.elogbook.org/logbookclient/ logon/. Accessed September 23, 2013 C. Royal College of Ophthalmologists. Preparing for appraisal and revalidation as an ophthalmologist. London, UK, The Royal College of Ophthalmologists, April 2013. Available at: http:// www.rcophth.ac.uk/core/core_picker/download.asp?idZ1341. Accessed September 23, 2013
Qualitative analysis of Web-based refractive surgery information sessions Roni M. Shtein, MD, MS, Paul P. Lee, MD, JD Patient-centered care is based on a virtuous cycle of mutual communication and shared decision making.1 Although the options for communications are proliferating with technological advances, Webbased information sessions for ophthalmic health care communications have not been evaluated in detail. We conduct a yearly, anonymous Web-based information session for individuals interested in corneal refractive surgery. In this analysis, we evaluated transcripts of these sessions from 2008 to 2012 to assess the content and nature of the discussions. The hour-long Web-based chat sessions were provided by a single corneal refractive surgeon and an ophthalmic technician at the Kellogg Eye Center
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CORRESPONDENCE
using ParaChatA from 2008 to 2011 and CoverItLiveB in 2012. Transcripts of the sessions were analyzed using qualitative analysis methods similar to those used for analysis of in-person focus groups. This study adheres to the Declaration of Helsinki and was granted exempt status by the University of Michigan Institutional Review Board. Chat sessions ranged from 9 to 39 questions, with the surgeon answering 67% to 89% of the questions and the refractive surgery technician answering 11% to 33%. Discussions with more questions had a higher rate of technician participation. Common themes and specific questions are described in Table 1. In 3 of the 5 sessions, most questions were in the first person and included personal experiences; in these, 1 of the first 3 questions of the session was phrased in this manner. In the remaining 2 sessions, almost all questions were phrased in the third person or as hypothetical situations. Most questions indicated curiosity and potential candidacy for refractive surgery. In 3 chats, there were participants who made it clear that they had had laser in situ keratomileusis (LASIK) but still had questions about the surgery. Web-based discussion enables dissemination of information to interested members of the public and effective gathering of information from patients, in this instance about refractive surgery. Our qualitative analysis reveals several common themes, including cost, logistics, and surgery eligibility. We found that the overall tone of the discussion was set in the first few questions, similar to other forms of on-line discussions.2 In addition to the firstversus third-person context, a single mention of risks of surgery tended to be followed by further related inquiries. We encountered several individuals who had had LASIK and therefore had their own refractive surgeon but chose to use this Web-based forum to ask questions. This highlights the potential complementary nature of Web-based or other forms of communication. Web-based communication for data collection through questionnaire and survey data has been performed for years. Studies have shown that Webbased focus groups provide comparable results to in-person focus groups, with the advantages of providing relative anonymity,3 increased availability as participants can access the focus group at locations and times most convenient to them,4,5 the possibility of long-term focus group discussions,4 and decreased costs.5 Internet accessibility is increasing with new technology and is often logistically easier than an in-person appointment.6 People, including older patients, are becoming more comfortable with this technology.7 Reaching diverse populations through the Web can
Table 1. Key findings of refractive surgery Web-based information sessions. General Themes Cost
Logistics
Patient eligibility
Surgical techniques
Risks of surgery
Patients with prior refractive surgery
Specific Areas of Concern Cost of preoperative evaluation Cost of surgery Insurance coverage Use of health care reimbursement account Advertisements on television and radio Scheduling surgery Length of surgery Time for recovery Activity restrictions Age Stability of refraction Astigmatism Presbyopia Coexisting medical and ocular conditions LASIK LASEK/PRK Intraocular surgical options Custom ablation Monovision Newer technologies Dry eye Light sensitivity Flap dislocation Residual prescription Regression Dry eye Night vision Residual astigmatism
LASEK Z laser-assisted subepithelial keratomileusis; LASIK Z laser in situ keratomileusis; PRK Z photorefractive keratectomy
be challenging, but a thoughtful approach can overcome such barriers.8 Illiteracy, vision limitations, and speaking different languages can be mitigated with programs that allow reading, voice recognition, and translation. With this analysis, we begin to explore the use of Web-based communication for qualitative health care research in ophthalmology. Further research is needed to understand the utility of this mode of communication and its potential usefulness in a variety of ophthalmic conditions. REFERENCES gare F, Ratte S, Stacey D, Kryworuchko J, Gravel K, 1. Le Graham ID, Turcotte S. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2010; 12:CD006732
J CATARACT REFRACT SURG - VOL 40, JANUARY 2014
CORRESPONDENCE
2. Armstrong N, Koteyko N, Powell J. ‘Oh dear, should I really be saying that on here?’: issues of identity and authority in an online diabetes community. Health (London) 2012; 16: 347–365 €rnberg S, 3. Blomberg K, Tishelman C, Ternestedt B-M, To l A, Widmark C. How can young women be encouraged Leva to attend cervical cancer screening? Suggestions from faceto-face and internet focus group discussions with 30-year-old women in Stockholm, Sweden. Acta Oncol 2011; 50:112–120. Available at: http://informahealthcare.com/doi/pdf/10.3109/ 0284186X.2010.528790. Accessed September 24, 2013 4. Kramish Campbell M, Meier A, Carr C, Enga Z, James AS, Reedy J, Zheng B. Health behavior changes after colon cancer: a comparison of findings from face-to-face and on-line focus groups. Fam Community Health 2001; 24(3):88–103 5. Kenny AJ. Interaction in cyberspace: an online focus group. J Adv Nurs 2005; 49:414–422 6. Fortney JC, Burgess JF Jr, Bosworth HB, Booth BM, Kaboli PJ. A re-conceptualization of access for 21st century healthcare.
161
J Gen Intern Med 2011; 2(suppl 2):S639–S647. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191218/pdf/ 11606_2011_Article_1806.pdf. Accessed September 24, 2013 7. Ammann R, Vandelanotte C, de Vries H, Mummery K. Can a website-delivered computer-tailored physical activity intervention be acceptable, usable, and effective for older people? Health Educ Behav 2013; 40:160–170 8. Suarez-Balcazar Y, Balcazar FE, Taylor-Ritzler T. Using the internet to conduct research with culturally diverse populations: challenges and opportunities. Cultur Divers Ethnic Minor Psychol 2009; 15:96–104. Available at: http://research.nmsu.edu/ compliance/IRB/articles/Using_the_Internet_to_Conduct.pdf? idZ35. Accessed September 24, 2013
OTHER CITED MATERIAL A. Chat.parachat. Available at http://chat.parachat.com. Accessed September 24, 2013. B. CoverItLive. Available at: http://www.coveritlive.com. Accessed September 24, 2013.
J CATARACT REFRACT SURG - VOL 40, JANUARY 2014
159
Figure 1. Top left: The corrected distance visual acuity (CDVA) achieved in this series (red) compared with CDVA achieved by other EUREQUO surgeons across Europe (green). Top right: Biometry prediction error, percentage within 1.0 diopter deviation from intended achieved in this series (red) compared with biometry prediction error achieved by other EUREQUO surgeons across Europe (green). Bottom left: Capsule complication rate (%) in this series (red) compared with capsule complication rate of other EUREQUO surgeons across Europe (green). Bottom right: Biometry prediction error in this series (red) compared with biometry prediction error of other EUREQUO surgeons across Europe (green). supervision provided by accredited training posts. Surgeon 2011; 9(suppl 1):S14–S15 4. Watters DAK, Green AJ, van Rij A. Requirements for trainee logbooks. ANZ J Surg 2006; 76:181–184 5. Watters DAK, Green AJ, van Rij A. Guidelines for surgical audit in Australia and New Zealand. ANZ J Surg 2006; 76:78–83
OTHER CITED MATERIAL A. Royal College of Ophthalmologists. Logbook. London, UK. The Royal College of Ophthalmologists, 2011. Available at: http://www.rcophth.ac.uk/page.asp?sectionZ152§ionTitleZLogbook. Accessed September 23, 2013 B. Royal College of Surgeons Edinburgh. The Pan-Surgical Electronic Logbook for the United Kingdom & Ireland - A log book for life. Available at: https://www.elogbook.org/logbookclient/ logon/. Accessed September 23, 2013 C. Royal College of Ophthalmologists. Preparing for appraisal and revalidation as an ophthalmologist. London, UK, The Royal College of Ophthalmologists, April 2013. Available at: http:// www.rcophth.ac.uk/core/core_picker/download.asp?idZ1341. Accessed September 23, 2013
Qualitative analysis of Web-based refractive surgery information sessions Roni M. Shtein, MD, MS, Paul P. Lee, MD, JD Patient-centered care is based on a virtuous cycle of mutual communication and shared decision making.1 Although the options for communications are proliferating with technological advances, Webbased information sessions for ophthalmic health care communications have not been evaluated in detail. We conduct a yearly, anonymous Web-based information session for individuals interested in corneal refractive surgery. In this analysis, we evaluated transcripts of these sessions from 2008 to 2012 to assess the content and nature of the discussions. The hour-long Web-based chat sessions were provided by a single corneal refractive surgeon and an ophthalmic technician at the Kellogg Eye Center
J CATARACT REFRACT SURG - VOL 40, JANUARY 2014
160
CORRESPONDENCE
using ParaChatA from 2008 to 2011 and CoverItLiveB in 2012. Transcripts of the sessions were analyzed using qualitative analysis methods similar to those used for analysis of in-person focus groups. This study adheres to the Declaration of Helsinki and was granted exempt status by the University of Michigan Institutional Review Board. Chat sessions ranged from 9 to 39 questions, with the surgeon answering 67% to 89% of the questions and the refractive surgery technician answering 11% to 33%. Discussions with more questions had a higher rate of technician participation. Common themes and specific questions are described in Table 1. In 3 of the 5 sessions, most questions were in the first person and included personal experiences; in these, 1 of the first 3 questions of the session was phrased in this manner. In the remaining 2 sessions, almost all questions were phrased in the third person or as hypothetical situations. Most questions indicated curiosity and potential candidacy for refractive surgery. In 3 chats, there were participants who made it clear that they had had laser in situ keratomileusis (LASIK) but still had questions about the surgery. Web-based discussion enables dissemination of information to interested members of the public and effective gathering of information from patients, in this instance about refractive surgery. Our qualitative analysis reveals several common themes, including cost, logistics, and surgery eligibility. We found that the overall tone of the discussion was set in the first few questions, similar to other forms of on-line discussions.2 In addition to the firstversus third-person context, a single mention of risks of surgery tended to be followed by further related inquiries. We encountered several individuals who had had LASIK and therefore had their own refractive surgeon but chose to use this Web-based forum to ask questions. This highlights the potential complementary nature of Web-based or other forms of communication. Web-based communication for data collection through questionnaire and survey data has been performed for years. Studies have shown that Webbased focus groups provide comparable results to in-person focus groups, with the advantages of providing relative anonymity,3 increased availability as participants can access the focus group at locations and times most convenient to them,4,5 the possibility of long-term focus group discussions,4 and decreased costs.5 Internet accessibility is increasing with new technology and is often logistically easier than an in-person appointment.6 People, including older patients, are becoming more comfortable with this technology.7 Reaching diverse populations through the Web can
Table 1. Key findings of refractive surgery Web-based information sessions. General Themes Cost
Logistics
Patient eligibility
Surgical techniques
Risks of surgery
Patients with prior refractive surgery
Specific Areas of Concern Cost of preoperative evaluation Cost of surgery Insurance coverage Use of health care reimbursement account Advertisements on television and radio Scheduling surgery Length of surgery Time for recovery Activity restrictions Age Stability of refraction Astigmatism Presbyopia Coexisting medical and ocular conditions LASIK LASEK/PRK Intraocular surgical options Custom ablation Monovision Newer technologies Dry eye Light sensitivity Flap dislocation Residual prescription Regression Dry eye Night vision Residual astigmatism
LASEK Z laser-assisted subepithelial keratomileusis; LASIK Z laser in situ keratomileusis; PRK Z photorefractive keratectomy
be challenging, but a thoughtful approach can overcome such barriers.8 Illiteracy, vision limitations, and speaking different languages can be mitigated with programs that allow reading, voice recognition, and translation. With this analysis, we begin to explore the use of Web-based communication for qualitative health care research in ophthalmology. Further research is needed to understand the utility of this mode of communication and its potential usefulness in a variety of ophthalmic conditions. REFERENCES gare F, Ratte S, Stacey D, Kryworuchko J, Gravel K, 1. Le Graham ID, Turcotte S. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2010; 12:CD006732
J CATARACT REFRACT SURG - VOL 40, JANUARY 2014
CORRESPONDENCE
2. Armstrong N, Koteyko N, Powell J. ‘Oh dear, should I really be saying that on here?’: issues of identity and authority in an online diabetes community. Health (London) 2012; 16: 347–365 €rnberg S, 3. Blomberg K, Tishelman C, Ternestedt B-M, To l A, Widmark C. How can young women be encouraged Leva to attend cervical cancer screening? Suggestions from faceto-face and internet focus group discussions with 30-year-old women in Stockholm, Sweden. Acta Oncol 2011; 50:112–120. Available at: http://informahealthcare.com/doi/pdf/10.3109/ 0284186X.2010.528790. Accessed September 24, 2013 4. Kramish Campbell M, Meier A, Carr C, Enga Z, James AS, Reedy J, Zheng B. Health behavior changes after colon cancer: a comparison of findings from face-to-face and on-line focus groups. Fam Community Health 2001; 24(3):88–103 5. Kenny AJ. Interaction in cyberspace: an online focus group. J Adv Nurs 2005; 49:414–422 6. Fortney JC, Burgess JF Jr, Bosworth HB, Booth BM, Kaboli PJ. A re-conceptualization of access for 21st century healthcare.
161
J Gen Intern Med 2011; 2(suppl 2):S639–S647. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191218/pdf/ 11606_2011_Article_1806.pdf. Accessed September 24, 2013 7. Ammann R, Vandelanotte C, de Vries H, Mummery K. Can a website-delivered computer-tailored physical activity intervention be acceptable, usable, and effective for older people? Health Educ Behav 2013; 40:160–170 8. Suarez-Balcazar Y, Balcazar FE, Taylor-Ritzler T. Using the internet to conduct research with culturally diverse populations: challenges and opportunities. Cultur Divers Ethnic Minor Psychol 2009; 15:96–104. Available at: http://research.nmsu.edu/ compliance/IRB/articles/Using_the_Internet_to_Conduct.pdf? idZ35. Accessed September 24, 2013
OTHER CITED MATERIAL A. Chat.parachat. Available at http://chat.parachat.com. Accessed September 24, 2013. B. CoverItLive. Available at: http://www.coveritlive.com. Accessed September 24, 2013.
J CATARACT REFRACT SURG - VOL 40, JANUARY 2014
