Living with AMD treatment - a qualitative study.

Abstract

Purpose:
Anti-VegF therapy for the treatment of neovascular AMD has clear clinical and quality of life benefits, as shown in numerous well conducted studies. It is now being implemented in many healthcare systems. However, treatment often involves multiple assessments and intravitreal drug injections, usually over an extended period of time. How do patients view this process, particularly at the outset, and how does their actual experience affect their views?

Methods:
Fifteen patients (mean age 76y; 6 males) were recruited and interviewed using the Biographical Narrative Interview Method (BNIM) before or just after treatment was commenced. At the end of the BNIM interview, a VFQ25 was also completed. Nine patients were interviewed several months later after they had received at least the loading dose of three injections. A semi-structured interview technique was used and the MacTSQ (a specific treatment satisfaction questionnaire, in which patients score their most recent treatment episode) administered. Interview data was subjected to thematic analysis, and VFQ25 and MacTSQ data scored and collated in accordance with published procedures.

Results:
The intersubject mean (±SD) VFQ25 General Health and General Vision scores were 57±29 and 61±26 respectively; Near Activities scored 65±32. In BNIM interviews almost all patients said that they had known relatively little about what treatment would entail other than that it required injections into their eye. They reported considerable apprehension pre-treatment. However, post-treatment interview data demonstrated that this apprehension was defused by actual treatment experience. None experienced serious adverse events, and few reported experiencing serious discomfort. Where this did occur, it did not discourage patients from continuing with treatment. These reports were complemented by the Mac TSQ data. The mean overall score was 65±5/72 (a higher score indicates greater satisfaction). Item 6 specifically asks "How apprehensive did you feel about your most recent treatment?". The mean score was 5.2±1.1/6 (where 6="Not apprehensive at all"). Many patients compared their treatment favourably to dental treatment.

Conclusions:
Our results suggest that patients are, in general, very happy with their treatment experience, returning high scores on the MacTSQ. Better information provision at the outset of their treatment journey may be of value in defusing further the apprehension that they reported in initial interviews.