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February 2018Consumer information on cataract surgeryAn environmental scanPublished by the Australian Commission on Safety and Quality in Health CareLevel 5, 255 Elizabeth Street, Sydney NSW 2001Phone: (02) 9126 3600Fax: (02) 9126 3613Email: mail@.au Website: .au ISBN: 978-1-925665-35-2? Australian Commission on Safety and Quality in Health Care 2018All material and work produced by the Australian Commission on Safety and Quality in Health Care is protected by copyright. The Commission reserves the right to set out the terms and conditions for the use of such material. As far as practicable, material for which the copyright is owned by a third party will be clearly labelled. The Australian Commission on Safety and Quality in Health Care has made all reasonable efforts to ensure that this material has been reproduced in this publication with the full consent of the copyright owners.With the exception of any material protected by a trademark, any content provided by third parties, and where otherwise noted, all material presented in this publication is licensed under a?Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence.Enquiries regarding the licence and any use of this publication are welcome and can be sent to communications@.au.The Commission’s preference is that you attribute this publication (and any material sourced from it) using the following citation: Australian Commission on Safety and Quality in Health Care. Consumer information on cataract surgery: An environmental scan. Sydney: ACSQHC; 2018 DisclaimerThe content of this document is published in good faith by Australian Commission on Safety and Quality in Health Care (the Commission) for information purposes. The document is not intended to provide guidance on particular health care choices. You should contact your health care provider on particular health care choices. Please note that there is the potential for minor revisions of this report.The Commission does not accept any legal liability for any injury, loss or damage incurred by the use of, or reliance on, this document. TOC \o "1-2" \h \z \u Introduction PAGEREF _Toc506453333 \h 4This paper PAGEREF _Toc506453334 \h 4Cataract surgery in Australia PAGEREF _Toc506453335 \h 5Atlas data on cataract surgery PAGEREF _Toc506453336 \h 5Review of consumer information on cataract PAGEREF _Toc506453337 \h 6Methodology PAGEREF _Toc506453338 \h 6Preliminary assessments of quality using DISCERN PAGEREF _Toc506453339 \h 8Conclusion PAGEREF _Toc506453340 \h 15Appendix 1 PAGEREF _Toc506453341 \h 16Appendix 2 PAGEREF _Toc506453342 \h 30References PAGEREF _Toc506453343 \h 39IntroductionThe Australian Commission on Safety and Quality in Health Care (the Commission) was established in 2006 to lead and coordinate national improvements in safety and quality in health care. Since that time the Commission has helped identify, raise awareness of and take action on key safety and quality issues within the healthcare system. An important part of the Commission’s work has been to explore the links between safety and quality and person-centred care, and support the consumer role in safety and quality. This focus is a core part of the Commission’s strategic approach to safety and quality.Partnering with consumers is integral to a number of the Commission’s national frameworks including the Australian Safety and Quality Framework for Healthcare, the Australian Charter of Healthcare Rights and the National Safety and Quality Health Service Standards.In order for healthcare providers to partner with consumers in their own care they must work with patients, families, friends and other support people to understand and address the needs and preferences of the patient. Healthcare providers must treat patients holistically and comprehensively with dignity and respect, collaborating, and sharing decisions and responsibility for care.For these kinds of partnerships to work well, information needs to be provided to consumers in a way that is easy to understand and use and that is clear and describes the options, risks and benefits of different treatment pathways. However, there is currently a vast amount of information available to consumers on health and health care that is extremely variable in quality. The Commission is working to identify whether high-quality health information exists for some key safety and quality issues. This process involves identifying the information that is available, assessing the quality of the information, and determining whether any additional information or resources might be required to support consumer understanding of their healthcare options.* This paperThe first Australian Atlas of Healthcare Variation (Atlas) identified substantial variation in cataract surgery across Australia. It was proposed that one of the contributing factors to this variation may have been consumers’ understanding of the treatment options for cataracts, and that this understanding may have been influenced by the type and quality of consumer information resources available. The Commission has undertaken an environmental scan to identify consumer information resources on cataracts. This report describes this work including data on variation in cataract surgery that was highlighted in the first Atlas, the methods used for identifying and assessing the quality of health information resources, and key findings of the review. Cataract surgery in AustraliaA cataract is the clouding of the eye’s clear lens and is a very common cause of reduced vision. Among Australians aged 55 and over, cataract is the primary cause of visual impairment in 40% of cases. The two most common symptoms are reduced visual function and sensitivity to glare. The most common risk factor for cataracts is age. The risk of having cataracts is also increased by diabetes, smoking and exposure to ultraviolet light. ADDIN EN.CITE <EndNote><Cite><Author>Australian Commission on Safety and Quality in Health Care</Author><Year>2015</Year><RecNum>2615</RecNum><DisplayText><style face="superscript">1, 2</style></DisplayText><record><rec-number>2615</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2615</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Australian Commission on Safety and Quality in Health Care,</author></authors></contributors><titles><title>Australian Atlas of Healthcare Variation</title></titles><dates><year>2015</year></dates><pub-location>Australia</pub-location><publisher>ACSQHC</publisher><urls></urls></record></Cite><Cite><Author>American Academy of Ophthalmology</Author><Year>2016</Year><RecNum>2617</RecNum><record><rec-number>2617</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2617</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>American Academy of Ophthalmology,</author></authors></contributors><titles><title>Cataract in the Adult Eye Preferred Practice Pattern</title></titles><dates><year>2016</year></dates><pub-location>San Francisco, United States</pub-location><publisher>Elsevier Inc.</publisher><urls><related-urls><url>(1).pdf</url></related-urls></urls></record></Cite></EndNote>1, 2 The presence of cataract does not necessarily indicate the need for surgery. In the early stages, symptoms may improve with new glasses, magnifying lenses or brighter lighting. Surgery is indicated when reduced vision affects a person’s daily functioning. However, the preferences of the consumer or surgeon may influence the decision on whether and when to perform surgery. ADDIN EN.CITE <EndNote><Cite><Author>Australian Commission on Safety and Quality in Health Care</Author><Year>2015</Year><RecNum>2615</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>2615</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2615</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Australian Commission on Safety and Quality in Health Care,</author></authors></contributors><titles><title>Australian Atlas of Healthcare Variation</title></titles><dates><year>2015</year></dates><pub-location>Australia</pub-location><publisher>ACSQHC</publisher><urls></urls></record></Cite></EndNote>1 Cataract surgery is one of the most common operations performed in Australia and involves replacing the cloudy lens with a clear, permanent, artificial lens. ADDIN EN.CITE <EndNote><Cite><Author>Australian Commission on Safety and Quality in Health Care</Author><Year>2015</Year><RecNum>2615</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>2615</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2615</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Australian Commission on Safety and Quality in Health Care,</author></authors></contributors><titles><title>Australian Atlas of Healthcare Variation</title></titles><dates><year>2015</year></dates><pub-location>Australia</pub-location><publisher>ACSQHC</publisher><urls></urls></record></Cite></EndNote>1 Atlas data on cataract surgeryThe first Atlas reported on variation in cataract surgery for adults 40 years and over. The Atlas reported that in 2013-14:There were 160,489 MBS-funded services for cataract surgery, representing 1,436 services per 100,000 people aged 40 years and over The average number of services varied across states and territories, from 1,132 per 100,000 people aged 40 years and over in the Northern Territory, to 1,685 in Queensland After excluding the highest and lowest results, the cataract surgery rate across the 298 remaining local areas was 2.8 times higher in the highest local area compared to the lowest Rates of cataract surgery decrease, as remoteness increasesGenerally rates were lowest in areas of low socioeconomic status and increased in areas with higher socioeconomic status. ADDIN EN.CITE <EndNote><Cite><Author>Australian Commission on Safety and Quality in Health Care</Author><Year>2015</Year><RecNum>2615</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>2615</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2615</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Australian Commission on Safety and Quality in Health Care,</author></authors></contributors><titles><title>Australian Atlas of Healthcare Variation</title></titles><dates><year>2015</year></dates><pub-location>Australia</pub-location><publisher>ACSQHC</publisher><urls></urls></record></Cite></EndNote>1 Some reasons proposed for this variation include: Differing access to and use of private health insurance. For example some populations such as Aboriginal and Torres Strait Islander peoples have low rates of private health insurance and reduced access to private hospitals. In NSW, 80 per cent of Aboriginal and Torres Strait Islander cataract surgery patients are public patients, compared with 28 per cent of non-Indigenous Australian patients Availability of specialists in rural and remote locations Government policies such as those where governments purchase the services of private providers in private hospitals for public patients. ADDIN EN.CITE <EndNote><Cite><Author>Australian Commission on Safety and Quality in Health Care</Author><Year>2015</Year><RecNum>2615</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>2615</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2615</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Australian Commission on Safety and Quality in Health Care,</author></authors></contributors><titles><title>Australian Atlas of Healthcare Variation</title></titles><dates><year>2015</year></dates><pub-location>Australia</pub-location><publisher>ACSQHC</publisher><urls></urls></record></Cite></EndNote>1 The first Atlas made suggestions about where to focus efforts to identify and address unwarranted variation in cataract surgery. One of the recommendations was that the Commission ‘undertakes a quality review of existing patient information about cataract surgery as part of developing supporting material for a Clinical Care Standard on cataract surgery’. ADDIN EN.CITE <EndNote><Cite><Author>Australian Commission on Safety and Quality in Health Care</Author><Year>2015</Year><RecNum>2615</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>2615</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2615</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Australian Commission on Safety and Quality in Health Care,</author></authors></contributors><titles><title>Australian Atlas of Healthcare Variation</title></titles><dates><year>2015</year></dates><pub-location>Australia</pub-location><publisher>ACSQHC</publisher><urls></urls></record></Cite></EndNote>1 This environmental scan reports on this review.Review of consumer information on cataractProviding understandable and accessible health information can improve people’s knowledge, understanding and recall about their health and care.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Kb2huc29uPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48
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ADDIN EN.CITE.DATA 5-7For consumers with cataract, the availability of high-quality information about treatment options including their risks, benefits and likely outcomes is integral to support informed decision making about whether and when to have cataract surgery. The following sections describe how the Commission identified, reviewed and assessed health information on cataracts.MethodologySeveral complementary strategies were used to identify consumer information about cataract surgery for this review. The review focused on consumer information about cataract surgery from Australian sources, supplemented by targeted exploration of resources from key leading international organisations.An internet search using the search engine Google and internet browser Chrome was conducted between March and April 2017. Separate searches were performed with results limited to the first 20 websites identified (excluding advertisements and map results), for each of the terms:Patient information cataract surgery auConsumer information cataract surgery auPatient information cataract operation auConsumer information cataract operation auQuestion cataract surgery auQuestion cataract operation auDecision cataract surgery auDecision cataract operation auOptions cataract surgery auOptions cataract operation auLeading condition-specific organisations and professional bodies in Australia, relevant to eye health and cataract surgery were also identified and searches undertaken for consumer information from their homepages. These organisations were:Royal Australasian and New Zealand College of Ophthalmologists (RANZCO)Australian Ophthalmic Nurses’ Association (AONA)Australian Society of Ophthalmologists (ASO)The Royal Australasian College of Surgeons (RACS)Australian College of Nursing (ACN)Optometry AustraliaCentre for Eye Research Australia (CERA)Vision AustraliaFred Hollows FoundationVision 2020Specific searches were also conducted for patient information on cataract surgery from the homepages of a range of key international organisations. These organisations were:Wikipedia (International)The King’s Fund (England)Patient Voices (England)Agency for Healthcare Research and Quality (United States)National Health Service (England)Ottawa Hospital Research Institute Patient Decision Aids (Canada)National Institute for Health and Care Excellence (England)Royal College of Surgeons (England)Royal College of Ophthalmologists (England)The Commission also asked nominees to the Cataract Surgery Topic Working Group to identify and submit any consumer information resources on cataract surgery which they knew were being used by health professionals or professional colleges. The national and state and territory peak consumer organisations were also contacted and invited to provide any materials relevant to the review.The resources identified through each of the search strategies were initially assessed for relevance and those which did not align with the definition of consumer health information used for this review were discarded. Duplicated results were also excluded from further assessment. This process identified a total of 81 discrete consumer information resources on cataract surgery for further quality assessment which are included in Appendix 1. Figure 1 illustrates the number of resources identified from each search strategy, together with exclusions and the final items retained for further quality assessment.Figure 1: Search result refinement processFor each of the resources retained for further assessment, the following information was recorded where available:How it was identifiedTitle of information Type of resource (consumer information about a single option, consumer information about multiple options, option grid, patient decision aid) Format (web-based, printable, audiovisual)LengthAuthorURL Source type and country (e.g. government, hospital, day procedure service, professional organisation etc.)Year published.Preliminary assessments of quality using DISCERNThe DISCERN instrument was chosen as a framework to assess and compare the quality of the large number of consumer resources on cataract surgery identified through the review.The DISCERN instrument was the first standardised index for assessing the quality of consumer health information. ADDIN EN.CITE <EndNote><Cite><Author>Treadgold</Author><Year>2014</Year><RecNum>2497</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>2497</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2497</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Treadgold, Paul</author><author>Grant, Carol</author></authors><tertiary-authors><author>Patient Information Forum</author></tertiary-authors></contributors><titles><title>Evidence Review: what does good health information look like?</title></titles><pages>57</pages><dates><year>2014</year><pub-dates><date>October</date></pub-dates></dates><pub-location>London</pub-location><publisher>Patient Information Forum & Grant Riches Communication Consultants Ltd</publisher><urls></urls><access-date>7 March 2017</access-date></record></Cite></EndNote>8 It was developed as a validated tool to help users of consumer health information judge the quality of written information about treatment choices.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5ESVNDRVJOPC9BdXRob3I+PFJlY051bT4yNTI4PC9SZWNO
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ADDIN EN.CITE.DATA 9-11 It is designed to assist in rating the quality of a publication in terms of its content and has a dual focus on the reliability and quality of information on treatment choices. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1999</Year><RecNum>2521</RecNum><DisplayText><style face="superscript">11, 12</style></DisplayText><record><rec-number>2521</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2521</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Charnock, Deborah</author><author>Shepperd, Sasha</author><author>Needham, Gill</author><author>Gann, Robert</author></authors></contributors><titles><title>DISCERN: an instrument for judging the quality of written consumer health information on treatment choices</title><secondary-title>Journal of Epidemiology and Community Health</secondary-title></titles><periodical><full-title>Journal of Epidemiology and Community Health</full-title></periodical><pages>105-111</pages><volume>53</volume><number>2</number><dates><year>1999</year></dates><urls><related-urls><url> app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url>, 12 The DISCERN instrument has a 5-point rating scale and asks a series of 15 questions to help determine the quality of the resource. The ratings for each of the DISCERN questions are aggregated into an overall rating of the resource. Appendix 2 includes a list of DISCERN questions, and the following sections describe how the 81 consumer resources on cataract surgery performed against the assessment.Question 1: Are the aims clear?Few of the resources explicitly stated what the information was about, what it would cover or who might find it useful. Such introductory content is important to orientate readers and allow them to make a judgement about whether the resource is relevant for them and their circumstances. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> In its absence, consumers are left to infer the aims of the resource from its title and headings with a greater or lesser degree of accuracy. Even among the nine resources judged to be of higher quality, only four rated highly (rating of 4 or 5) on this particular item (Resources no. 64, 65, 67, 81) indicating that this is an area of weakness in the consumer information about cataract surgery currently available.Question 2: Does it achieve its aims?Given few resources explicitly stated the aim it was difficult to identify whether the resources achieved their goal. However, when allowing for the inference of aims from the title and headings of the publications, the majority of resources were rated moderately or highly (rating of 4 or 5) for this item. Of the nine resources judged to be of higher quality, all were rated highly on this particular item (Resources no. 30, 58, 62, 63, 64, 65, 67, 76, 81). Question 3: Is it relevant?Judging the relevance of the resources included a consideration of whether the publication addressed questions that consumers might ask and whether the recommendations and suggestions about treatment choices were appropriate or realistic. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For consumers with cataract, a publication’s relevance will be influenced by individual circumstances and factors related to the content and presentation of the resource. A large majority of the reviewed resources were rated moderately or highly (rating of 4 or 5) for this item, indicating that this is a strength of the consumer information on cataract surgery currently available. Of the nine resources judged to be of higher quality, all were rated highly on this particular item (Resources no. 30, 58, 62, 63, 64, 65, 67, 76, 81). Question 4: Is it clear what sources of information were used to compile the publication (other than the author or producer)?Few of the resources included references to the sources of information used as evidence, or included a way to check the sources used such as a bibliography, reference list or the contact details of experts or organisations quoted. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> This was true for the resources produced by individual health service organisations and the majority of those authored by professional bodies, condition-specific organisations and government agencies. Of the nine resources judged to be of higher quality only two, one by Wikipedia and the other by NHS RightCare, were rated highly (rating of 5) on this item (Resources no. 58, 81). The absence of references and other ways for consumers to check evidence sources is a limitation of the consumer information on cataract surgery currently available.Question 5: Is it clear when the information used or reported in the publication was produced?Assessing resources against this criterion included looking for dates of the main evidence sources, as well as the date of publication and any revisions to the resource itself. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> Due to the low levels of referencing and evidence source identification across all of the resources, dates for the information used to compile the publications were also lacking. For a substantial minority there was no information provided, inferred or otherwise, by which a consumer could judge when a resource had been published. Of the nine resources judged to be of higher quality only three were rated highly (rating of 4 and 5) for this item (Resources no. 58, 64, 81), identifying a potential opportunity for improvement.Question 6: Is it balanced and unbiased?This assessment criterion required a consideration of whether the resource was written from a personal or objective point of view, if there was evidence that a range of sources were used to compile it, and if any external assessment of the publication had occurred. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> While very few resources presented information about cataract surgery in an emotive or alarmist way, the substantial majority were not rated highly for this item as the source of their statements were unclear or unreferenced. While some consumers would be likely to infer that information published by government agencies, condition-specific organisations and professional bodies would be more objective and unbiased, the absence of clear markers such as evidence sources may create unnecessary confusion. Of the nine resources judged to be of higher quality, four were rated highly (4 and 5) for this particular item (Resources no. 58, 64, 65, 81). Question 7: Does it provide details of additional sources of support or information?Providing consumers with suggestions for further reading or details of other organisations able to give advice and information about treatment choices is an important element of high-quality information. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> Including these details in publications assists consumers to find any additional information they need to make decisions about treatment and care. For consumers with cataract this could include referral to leading eye-health organisations and links to professional bodies such as the Royal Australasian and New Zealand College of Ophthalmologists . Of the 81 resources reviewed, 12 included this kind of information to guide consumers, indicating an opportunity for further improvement. The nine resources judged to be of higher quality performed moderately on this item with five rated highly (rating of 4 or 5) (Resources no. 58, 62, 63, 65, 67). Question 8: Does it refer to areas of uncertainty?Discussing gaps in knowledge or differences in expert opinion about treatment choices is a key way in which consumer information can acknowledge where there is uncertainty. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For consumers with cataract, this may include information about when the optimal time is to have cataract surgery, as well as what artificial lens is most appropriate, whether procedures (laser vision correction and cataract removal) can occur concurrently, as well as differences in outcomes after surgery. Only 12 of the 81 resources reviewed referred to areas of uncertainty in a comprehensive way, showing room for increased attention to be paid to this element of high-quality consumer information. Of the nine resources judged to be of higher quality, seven were rated highly (rating of 4 or 5) for this item (Resources no. 64, 65, 58, 62, 63, 76, 81). Question 9: Does it describe how each treatment works?Providing detail about how a treatment acts on the body is a key piece of information consumers need to understand their treatment options, and make informed decisions. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For consumers with cataract this includes information about what happens to the eye during cataract surgery, including detail about how the procedure is carried out and what the patient can expect during that episode of their care. A substantial proportion of reviewed resources performed well on this item, with 27 of the 81 publications rated highly (rating of 4 or 5). Eight of the nine resources judged to be of higher quality also achieved a high rating for this item (rating of 4 or 5), indicating that this is an area of strength across the range of consumer information about cataract surgery (Resources no. 64, 67, 30, 58, 62, 63, 76, 81). Question 10: Does it describe the benefits of each treatment?Information about the benefits of treatment can include reducing or eliminating symptoms, preventing recurrence of the condition and getting rid of the condition, both short-term and long-term. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For consumers with cataract this comprises information about how vision will be affected by cataract surgery and the type of artificial lens used, as well as whether cataracts can reform and if there is a need for further surgery. ADDIN EN.CITE <EndNote><Cite><Author>Da Silva</Author><Year>2012</Year><RecNum>1761</RecNum><DisplayText><style face="superscript">2, 13</style></DisplayText><record><rec-number>1761</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">1761</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Da Silva, Debra</author></authors></contributors><titles><title>Helping people share decision making: A review of evidence considering whether shared decision making is worthwhile</title></titles><dates><year>2012</year></dates><pub-location>London</pub-location><publisher>The Health Foundation</publisher><urls></urls></record></Cite><Cite><Author>American Academy of Ophthalmology</Author><Year>2016</Year><RecNum>2617</RecNum><record><rec-number>2617</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2617</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>American Academy of Ophthalmology,</author></authors></contributors><titles><title>Cataract in the Adult Eye Preferred Practice Pattern</title></titles><dates><year>2016</year></dates><pub-location>San Francisco, United States</pub-location><publisher>Elsevier Inc.</publisher><urls><related-urls><url>(1).pdf</url></related-urls></urls></record></Cite></EndNote>2, 13 While there is a large body of evidence about the benefits of cataract surgery in terms of improving visual acuity and the capacity to perform activities of daily living ADDIN EN.CITE <EndNote><Cite><Author>Desai</Author><Year>1996</Year><RecNum>2621</RecNum><DisplayText><style face="superscript">14</style></DisplayText><record><rec-number>2621</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2621</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Desai, P</author><author>Reidy, A </author><author>Minassian, D </author><author>Vafidis, G</author><author>Bolger, J</author></authors></contributors><titles><title>Gains from cataract surgery: visual function and quality of life</title><secondary-title>British Journal of Ophthalmology </secondary-title></titles><periodical><full-title>British Journal of Ophthalmology</full-title></periodical><pages>868-873</pages><volume>80</volume><dates><year>1996</year></dates><urls><related-urls><url>, the majority of the resources reviewed did not make the benefits clear. This may reflect an assumption on the part of authors that consumers already know about the benefits of cataract surgery. Of the nine resources judged to be of higher quality, eight achieved ratings of 4 or 5 for this item (Resources no. 30, 58, 62, 63, 64, 65, 67, 81). Question 11: Does it describe the risks of each treatment?Most treatments involve some potential risks or disadvantages. Consumer resources that provide realistic information about these risks can help people make decisions about treatment in a more considered way. Risks can include side effects, complications and adverse reactions to treatment, both short-term and long-term. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For consumers with cataract, understanding the risks of cataract surgery is important for decisions about whether and when to have surgery. There was substantial variation in the extent to which the resources reviewed identified risks associated with cataract surgery, as well as in the level of detail they provided about frequency, severity and reversibility of the identified risks. This variability indicates another opportunity for quality improvement across the range of consumer resources on cataract surgery. However, of the nine resources assessed as higher quality, eight rated highly for this item (rating of 4 or 5) (Resources no. 58, 62, 63, 64, 65, 67, 76, 81). Question 12: Does it describe what would happen if no treatment is used?A high-quality consumer resource will include information about what would happen if the condition is left untreated. Understanding the outcome of having no treatment helps clarify what consumers can expect, and helps identify if not having any treatment is linked to an outcome that is important for them. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For consumers with cataract, information about what would happen if they do not have cataract surgery or choose to delay surgery can help them make informed choices about what health care they receive and when. The progression of cataract and its impact on visual acuity is well understood ADDIN EN.CITE <EndNote><Cite><Author>American Academy of Ophthalmology</Author><Year>2016</Year><RecNum>2617</RecNum><DisplayText><style face="superscript">2</style></DisplayText><record><rec-number>2617</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2617</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>American Academy of Ophthalmology,</author></authors></contributors><titles><title>Cataract in the Adult Eye Preferred Practice Pattern</title></titles><dates><year>2016</year></dates><pub-location>San Francisco, United States</pub-location><publisher>Elsevier Inc.</publisher><urls><related-urls><url>(1).pdf</url></related-urls></urls></record></Cite></EndNote>2, as are the strategies that consumers can use in the early stages of disease to manage symptoms such as new glasses, magnifying lenses or brighter lighting. ADDIN EN.CITE <EndNote><Cite><Author>Australian Commission on Safety and Quality in Health Care</Author><Year>2015</Year><RecNum>2615</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>2615</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2615</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Australian Commission on Safety and Quality in Health Care,</author></authors></contributors><titles><title>Australian Atlas of Healthcare Variation</title></titles><dates><year>2015</year></dates><pub-location>Australia</pub-location><publisher>ACSQHC</publisher><urls></urls></record></Cite></EndNote>1 However, the majority of resources reviewed did not include a description of what would occur if cataract was left untreated. This was linked to the type of resource, with consumer information about multiple options being more likely to describe what would happen than consumer information about a single option. Six of the nine resources identified to be of higher quality were rated highly for this item (rating of 4 or 5) (Resources no. 30, 62, 63, 64, 67, 81).PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWN1bGFyIERpc2Vhc2UgRm91bmRhdGlvbiBBdXN0cmFs
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ADDIN EN.CITE.DATA 15-19 Question 13: Does it describe how the treatment choices affect overall quality of life?Treatment choices may involve major changes in lifestyle or circumstances or have effects on family and friends that consumers need to know and consider before making a decision. A high quality resource will include information about the broader aspects of treatment choices on everyday life. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For consumers with cataract these include short-term factors such as not being able to drive immediately after surgery. Some long-term considerations might include impact on a person’s physical function, mental health, emotional well-being, safety, and overall quality of life. ADDIN EN.CITE <EndNote><Cite><Author>American Academy of Ophthalmology</Author><Year>2016</Year><RecNum>2617</RecNum><DisplayText><style face="superscript">2</style></DisplayText><record><rec-number>2617</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2617</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>American Academy of Ophthalmology,</author></authors></contributors><titles><title>Cataract in the Adult Eye Preferred Practice Pattern</title></titles><dates><year>2016</year></dates><pub-location>San Francisco, United States</pub-location><publisher>Elsevier Inc.</publisher><urls><related-urls><url>(1).pdf</url></related-urls></urls></record></Cite></EndNote>2 Few of the resources reviewed included a clear reference to overall quality of life in the information they provided. This weakness was also observed in those resources judged to be of higher quality with only three of the nine achieving a high rating of 4 and 5 for this item (Resources no. 30, 64, 81). Question 14: Is it clear that there may be more than one possible treatment choice?A high-quality resource will indicate that there is a choice about treatment, even if full details of the alternatives are not presented in the publication. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For people with cataract, the situation is somewhat different because surgery is the only way to effectively treat cataract and manage symptoms in later stages of the disease. ADDIN EN.CITE <EndNote><Cite><Author>American Academy of Ophthalmology</Author><Year>2016</Year><RecNum>2617</RecNum><DisplayText><style face="superscript">2</style></DisplayText><record><rec-number>2617</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2617</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>American Academy of Ophthalmology,</author></authors></contributors><titles><title>Cataract in the Adult Eye Preferred Practice Pattern</title></titles><dates><year>2016</year></dates><pub-location>San Francisco, United States</pub-location><publisher>Elsevier Inc.</publisher><urls><related-urls><url>(1).pdf</url></related-urls></urls></record></Cite></EndNote>2 For the purposes of this review and assessment against this item, the option to delay cataract surgery or elect not to have surgery at all are regarded as alternatives. The large majority of resources reviewed did not make it clear that there may be more than one possible treatment choice. As expected, consumer information about multiple treatment options as well as patient decision aids were more likely to be rated highly for this item (rating of 4 or 5) than consumer information about a single treatment option. Of the nine resources identified to be of higher quality, six performed well on this item, identifying an area where quality could be further enhanced (Resources no. 64, 65, 30, 63, 76, 81). Question 15: Does it provide support for shared decision making?Consumer resources can provide support for shared decision making by raising issues for consumers to discuss with clinicians about what are the best treatment choices for them. High quality consumer resources help consumers prepare for consultations with clinicians and to talk through issues that might affect people close to them regarding their care. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> For consumers with cataract, this could include issues such as treatment choices, risks and benefits, costs and outcomes. Only two of the consumer resources (Resource no. 64, 81), provided good support (rating of 4 or 5) for shared decision making. Providing support for consumers to share decisions about treatment choices is a gap in consumer information about cataract surgery currently available in Australia.Overall ratingAll consumer resources have deficiencies and it is unlikely that any single publication will rate highly for all of the items. ADDIN EN.CITE <EndNote><Cite><Author>Charnock</Author><Year>1998</Year><RecNum>2522</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>2522</rec-number><foreign-keys><key app="EN" db-id="st9a2pw9wxpvaqer2f3vf9anxvp295ffdfs2">2522</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Charnock, Deborah</author></authors><tertiary-authors><author>Radcliffe Medical Press</author></tertiary-authors></contributors><titles><title>The DISCERN Handbook: Quality criteria for consumer health information on treatment choices</title></titles><dates><year>1998</year></dates><pub-location>Oxon UK,</pub-location><urls><related-urls><url> Consumer information about cataract surgery is no different, as the results of this review indicate. While no single resource was rated highly across all of the criteria (rating of 4 or 5), nine resources were judged to be of higher quality. The individual ratings given for each of the 81 reviewed resources are included in Appendix 2 and details of the nine higher quality resources are listed in Table 1. Within this group are resources of different types and formats, authored by a range of organisations both within Australia and overseas. They provide a foundation of high quality information on which the Commission can draw when considering what kind of consumer resources could support a future clinical care standard on cataract surgery. Table 1: Highly rated consumer resources on cataract surgeryResource No.Overall DISCERN ratingTitleTypeFormatAuthorSource Type and countryYear Published304Cataracts and macular degeneration Consumer information about multiple optionsPrintableMacular Disease FoundationCondition specific organisation in Australia2016584Cataract Consumer information about a single optionWeb-basedWikipediaInternational web-based openly editable encyclopaedia2017624Cataract surgeryConsumer information about multiple optionsWeb-basedNHS ChoicesNational Health Service in the United Kingdom2016634Cataract service patient information: CataractConsumer information about multiple treatment optionsPrintableMoorfields Eye Hospital NHS Foundation TrustNational Health Service in the United Kingdom2014645Cataracts: Should I have surgery? Patient decision aidWeb-basedPrintableHealthwiseNot-for-profit provider of health information in the United States2017654Understanding NICE guidance – Information for people who use NHS services: Treating cataracts by implanting multifocal lensesConsumer information about a single treatment optionPrintableNational Institute for Health and Care Excellence (NICE)National health guidance and quality organisation in the United Kingdom2008674Understanding cataractsConsumer information about a single treatment optionPrintableRoyal College of Ophthalmologists and Royal National Institute of Blind PeopleProfessional body and condition specific organisation in the United Kingdom2013764Cataract SurgeryConsumer information about multiple treatment optionsPrintableLions Eye InstituteCondition specific medical research institute in Australia2014815Deciding what to do about cataractsConsumer information about multiple treatment optionsPrintableNHS RightCareNational Health Service in the United Kingdom2017ConclusionFor consumers with cataract, accessing high-quality information about cataract surgery can influence their expectations and preferences about treatment. The Commission has a role in supporting both access to and the use of high-quality information as a means of empowering consumers to work in partnership with their healthcare provider, and share decisions about health care. It may also help to reduce unwarranted variation in the treatment of some conditions.There is a large amount of information available to consumers about cataract surgery in Australia, however this information varies substantially in terms of its quality. This review suggests that the majority of consumer resources on cataract surgery have been developed with the aim of meeting the local needs of individual health service organisations, or professions, and may not be considered high-quality. Reviewing consumer health information resources on cataract surgery has identified a number of opportunities to improve quality within individual resources including by better articulating aims, demonstrating objectivity, linking statements about treatment choices with evidence sources, considering the effect of treatment choices on overall quality of life, and improving support for shared decision making. This review has, however, identified nine higher-quality resources that provide comprehensive information about risks, benefits, and options related to cataract surgery. Although none of these nine resources meets all criteria to the highest rating, overall they provide a reasonable basis to inform consumers about their options for cataract surgery. Consequently, rather that developing a new resource the Commission can best support consumers’ need to access to high-quality information about cataract surgery by directing consumers to the higher-quality resources that have been identified through this review. Appendix 1Consumer information resources on cataract surgeryResource No.TitleSearch strategy TypeFormatLengthAuthor and URLSource type and countryYear published1Cataract Frequently Asked QuestionsGoogle search 1: Patient information cataract surgery au B PI multiple options (surgery & no surgery)Web1 web page with collapsed contentCataract Care Centre VIC Australia2017Website ?2After cataract surgery: a post-surgical guideGoogle search 1: Patient information cataract surgery au A PI single option (surgery)Web1 web pageVision Eye Institute group NSW, QLD , Vic Australia2016Website ?3Patient Info CataractGoogle search 1: Patient information cataract surgery auBPI multiple options (surgery & delay surgery)Web1 web pageSouthern Opthalmology group NSW Australiaunknown4Cataract(s)Google search 1: Patient information cataract surgery auB PI multiple options (surgery & delay surgery)Printable PDF6 printed pagesEye Surgery Associates groupVicAustraliaunknownpdf ? 2007-135Cataract SurgeryGoogle search 1: Patient information cataract surgery auBPI multiple options (surgery & no surgery)Web 1 web page and videoLasersight groupQLD, Vic, NSW, Tas, WA Australia2015Website ?6CataractsGoogle search 1: Patient information cataract surgery auAPI single optionWeb1 web pageBetter Health Channel gov.Australia20147CataractsGoogle search 1: Patient information cataract surgery auBPI multiple treatment options (surgery & delay surgery)Web1 web pageHealthdirect. gov.Australia20158Can I help my healing after Cataract Surgery – Restrictions after Cataract Eye SurgeryGoogle search 1: Patient information cataract surgery auAPI single treatment optionWeb 1 web pageMedownick Laser Clinic Vic Australia2016Website ?9Cataract surgery consent formGoogle search 1: Patient information cataract surgery auA PI single treatment optionPrintable3 printable pagesQLD Health gov.Australia201110Laser Assisted Cataract SurgeryGoogle search 1: Patient information cataract surgery auAPI single treatment optionWeb1 web pageManningham Day Procedure Centre VicAustralia2017Website ?11Cataract surgeryGoogle search 1: Patient information cataract surgery auA PI single treatment optionWeb1 web pageHealthy WA gov.AustraliaUnknown12Cataract SurgeryGoogle search 1: Patient information cataract surgery auA PI single treatment optionWeb1 web pageCentral Sydney Eye Surgeons NSWAustraliaUnknown13Cataract Surgery – A Guide For PatientsGoogle search 1: Patient information cataract surgery auAPI single treatment optionPrintable15 brochure pagesSydney Cornea Clinic NSW AustraliaUnknown14Cataract SurgeryGoogle search 1: Patient information cataract surgery auAPI multiple treatment optionsPrintable4 printable pagesNorthern Sydney?Cataract Retina Glaucoma NSWAustraliaUnknown15CataractGoogle search 1: Patient information cataract surgery auAPI single treatment optionWeb1 web pageNepean Valley Eye Surgeons NSW AustraliaUnknown16Cataract Surgery – Post Operative AdviceGoogle search 2:Consumer information cataract surgery auAPI single treatment optionWeb 1 web pageBunbury Day Surgery WAAustralia2017Website ?17Laser?Assisted?Cataract SurgeryGoogle search 2:Consumer information cataract surgery auA PI single treatment optionWeb1 web pageOrange Surgery Centre NSWAustralia2012Website ?18Does Medicare cover the cost of laser cataract surgeryGoogle search 2:Consumer information cataract surgery auAPI single treatment optionWeb1 web pageThe Naked Eye affiliated with two Australian surgeons/ professors201519Cataract FAQsGoogle search 3: Patient information cataract operation auBPI multiple treatment optionWeb1 web pageVision Eye Institute group NSW, QLD, Vic Australia2016Website ?20CataractsGoogle search 3: Patient information cataract operation auAPI single treatment optionWeb1 web pageOptometry Australia organisation Australia2017Website ?21CataractGoogle search 3: Patient information cataract operation auBPI multiple treatment optionsWeb1 web pageSpecialist Eye Centre DPS NSWAustralia2017Website ?22Cataract surgery (phacoemulsification)Google search 4: Consumer information cataract operation auBPI multiple treatment optionsWeb and printable1 web page 3 printable pagesBetter Health Channel gov.Australia201523Cataract Surgery – Frequently Asked QuestionsGoogle search 5:Question cataract surgery auA single treatment optionWeb1 web pageAdelaide Eye & Laser Centre DPS SAAustralia2017Website ?24 Cataract surgeryGoogle search 5:Question cataract surgery auA single treatment optionWeb1 web pageHealthdirect Aus gov.Australia201625Cataract SurgeryGoogle search 5:Question cataract surgery auB multiple treatment optionsWeb1 web page and videosForest Eye Surgery NSWAustralia2017Website ?26Cataract SurgeryGoogle search 5:Question cataract surgery auA single treatment optionsWeb1 web pageAustralian Institute of Eye Surgery DPS NSWAustralia2017Website ?27Frequently Asked Questions (FAQ's)Google search 5:Question cataract surgery auA single treatment optionsWeb 1 web pageSydney Eye Clinic DPS NSWAustralia2017Website ?28Cataracts FAQsGoogle search 5:Question cataract surgery auB multiple treatment optionsWeb 1 web pageMetwest Eye Centre DPS NSW Australia2017Website ?29Laser Eye Surgery Frequently Asked QuestionsGoogle search 5:Question cataract surgery auA single treatment optionWeb 1 web pageThe Cataract Clinic DPS NSWAustralia2017Website ?30Cataracts and macular degenerationGoogle search 6: Question cataract operation auB multiple treatment optionsPrintable pdf4 printable pagesMacular Disease Foundation Australia Disease Specific Organisation Australia201631Spotlight on: Cataract?surgeryGoogle search 7: Decision cataract surgery auA single treatment optionWeb1 web pageVision Eye Institute DPS group NSW, Qld, Vic Australia2016Website ?32Cataract SurgeryGoogle search 7: Decision cataract surgery auA single treatment optionWeb16 linked web pages from a starting menuMedownick Laser Clinic DPS Vic Australia2016Website ?33 Cataract Google search 7: Decision cataract surgery auB multiple treatment optionsWeb1 web pageMoreton Eye Group DPS group Qld Australia2013Website ?34CataractGoogle search 7: Decision cataract surgery auA single treatment optionWeb1 web pageEye Surgeons SA DPS SAAustralia2014Website ?35CataractGoogle search 7: Decision cataract surgery auB multiple treatment optionsWeb 1 web pageDarling Downs Eye DPS QldAustralia2017Website ?36Cataract SurgeryGoogle search 7: Decision cataract surgery auA single treatment optionWeb1 web pageInner West Eye Surgeons DPS NSWAustralia2017Website ?37Cataract SurgeryGoogle search 7: Decision cataract surgery auB multiple treatment optionsWeb 1 web page with collapsible menusEyescan DPS Vic AustraliaUnknown38CataractGoogle search 7: Decision cataract surgery auA single treatment optionWeb1 web pageSouth Western Eye Care DPS NSWAustraliaUnknown39Cataract SurgeryGoogle search 7: Decision cataract surgery auB multiple treatment optionsWeb1 web page with collapsible menusVictorian Eye Surgeons DPS VicAustralia2014Website ?40CataractGoogle search 7: Decision cataract surgery auA single treatment optionWeb1 web pageCanberra Eye Hospital DPS ACTAustralia2017Website ?41 Back to basics – all about cataract surgeryGoogle search 7: Decision cataract surgery auA single treatment optionWeb1 web pageSydney Opthalmic Specialists DPS NSWAustralia201742 CataractGoogle search 7: Decision cataract surgery auA single treatment optionWeb 1 web pageVisionary Eye Specialists DPS NSWAustraliaUnknown43Laser Cataract Surgery and Phacoemulsification Cataract SurgeryGoogle search 8: Decision cataract operation auA single treatment option Web1 web pageEye Surgeons SA DPS SAAustralia2014Website ?44Cataract SurgeryGoogle search 8: Decision cataract operation auA single treatment optionWeb1 web pagePrecision Eye Clinic DPS TasAustralia2017Website ?45Cataract SurgeryGoogle search 8: Decision cataract operation auA single treatment optionWeb1 web pageNewcastle Eye Centre DPS NSW Australia2016Website ?46CataractsGoogle search 8: Decision cataract operation auB multiple treatment optionsWeb 1 web pageDr Anne Malatt Eye Surgeon DPS NSWAustraliaUnknown47Cataracts Google search 8: Decision cataract operation auB multiple treatment optionsWeb1 web pageMurdoch Eye Centre DPS WAAustralia2014Website ?48Cataract SurgeryGoogle search 8: Decision cataract operation auA single treatment optionWeb1 web pageDoncaster Eye Centre DPS VIC Australia2017Website ?49Cataract SurgeryGoogle search 8: Decision cataract operation auA single treatment optionWeb 1 web pageHCF Private Health InsurerAustralia2017Website ?50Cataract SurgeryGoogle search 8: Decision cataract operation auA single treatment optionWeb1 web pageDr Peter Chau Eye Surgeon DPS Vic AustraliaUnknown51Cataract surgery costGoogle search 9: Options cataract surgery auA single treatment optionWeb 1 web pageVision Eye Institute DPS group NSW, Qld, Vic Australia2016Website ?52Cataract Surgery Treatment Options in MelbourneGoogle search 9: Options cataract surgery auA single treatment optionWeb 1 web pageNewVision Clinics DPS group Vic Australia2014Website ? 53Cataract SurgeryGoogle search 9: Options cataract surgery auA single treatment optionWeb and printable pdf1 web page2 printable pagesPersonalEYES DPS group NSW Australia2016 Website ?54Cataract Surgery CostGoogle search 9: Options cataract surgery auA single treatment optionWeb1 web pageAll About Vision Disease specific organisation Australia(advertising present)201655Cataract Surgery: Cataracts TreatmentGoogle search 9: Options cataract surgery auA single treatment optionWeb1 web pagePersonalEYES DPS group NSWAustralia2016 Website ?56Cataract SurgeryGoogle search 10: Options cataract operation auA single treatment optionWeb 1 web pageInsight Eye Clinic DPS WAAustralia2016 Website ?57CataractsGoogle search 10: Options cataract operation auA single treatment optionWeb 1 web pageEye and Laser Surgeons DPS NSWAustraliaUnknown58CataractWikipediaA single treatment optionWeb1 web pageWikipedia Web-based, openly editable encyclopedia 201759Cataract SurgeryWikipedia A single treatment optionWeb1 web pageWikipedia Web-based, openly editable encyclopedia201760What Is a Cataract?AHRQ searchA single treatment optionWeb1 web pageAHRQ US national healthcare safety and quality organisation200761Age-related cataractsNHS searchB multiple treatment optionsWeb1 web pageNHS Choices UK national health service 201662Cataract surgeryGoogle searchB multiple treatment optionsWeb7 linked web pagesNHS Choices UK national health service201663Cataract service patient information: CataractGoogle searchB multiple treatment optionsPrintable13 printable pagesMoorfields Eye Hospital NHS Foundation Trust UK national health service201464Cataracts: Should I have surgery?OHRI searchPDAWeb, printable6 linked webpages; 9 printed pages Healthwise not-for-profit provider of health information, decision support tools, behavior change assistance etc 201765Understanding NICE guidance - Information for people who use NHS services: Treating cataracts by implanting multifocal lensesNICE searchPI about a single treatment optionWeb, printable4 printed pagesNICE UK national health guidance and quality organisation200866Get Well Soon: Helping you to make a speedy recovery after cataract surgeryRCS searchPI about a single treatment optionprintable16 printed pagesThe Royal College of Surgeons of England (1).pdfUK professional body201467Understanding cataractsRCOpth searchPI about a single treatment optionprintable24 printed pagesRCOpth and Royal National Institute of Blind People professional body and disease specific organisation201368Cataract: Specific Questions Related to Cataract SurgeryRCOpth searchPI about a single treatment optionsweb1 web pageRCOpth professional bodyUnknown69Find Out More About CataractsRANZCO searchPI about a single treatment optionweb1 web pageRANZCO professional body2016 Website ?70Cataract Surgery Online Patient AdvisoryRANZCO searchPI about a single treatment optionprintable1 printed pageRANZCO AU professional body201271CataractsASO searchPI about multiple treatment optionsweb1 web pageHealth& health management portal 201772CataractsOptometry Australia searchPI about a single treatment optionweb1 web pageOA professional body2017Website ?73CataractCentre for Eye Research searchPI about a single treatment optionweb1 web pageCERA eye research organisation201474CataractsVision Australia searchPI about a single treatment optionweb1 web pageVision Australia disease specific organisationUnknown75Cataracts in infancy and childhoodVision Australia searchPI about a single treatment optionweb1 web pageVision Australia disease specific organisationUnknown76Cataract SurgeryConsumer peak organisationPI about multiple treatment optionsprintable16 printable pagesLions Eye Institute disease specific medical research institute201477Cataract SurgeryTopic Working GroupPI about a single treatment optionprintable 5 printable pagesSydney Hospital and Sydney Eye HospitalNSW Hospitals201678Trachoma, Cataract, Diabetes and Your Eyes Topic Working GroupPI about a single treatment optionWeb printable39 printable pagesInternational Centre for Eyecare Education disease specific medical research institute200979Big City TripTopic Working GroupPI about a single treatment optionAudio-visual11minsSight for all OR AU disease specific organisation201380Eyes on the PrizeTopic Working GroupPI about a single treatment optionAudio-visual18minsFred Hollows Foundation OR AU disease specific organisation201581Deciding what to do about cataractsNHS RightCarePI about multiple treatment optionsWebprintable5 printable pagesNHS RightCare(1).pdfUK national health service2017Appendix 2DISCERN assessment resultsA rating scale of 1-5 (no to yes) is used for each DISCERN criteria. More information about this rating scale is included after the table.No.Type of resourceA: consumer information single option; B: consumer information multiple optionsC: option gridD: patient decision aid Are the aims clear?(1-5)Does it achieve its aims?(1-5)Is it relevant?(1-5)Is it clear what sources of info were used to complete the publication?(1-5)Is it clear when the info used or reported in the publication was produced?(1-5)Is it balanced and unbiased?(1-5)Does it provide details of additional sources of support or info?(1-5)Does it refer to areas of uncertainty?(1-5)Does it describe how each treatment works?(1-5)Does it describe the benefits of each treatment?(1-5)Does it describe the risks of each treatment?(1-5)Does it describe what would happen if no treatment was used?(1-5)Does it describe how treatment choices affect overall quality of life?(1-5)Is it clear that there may be more than one possible treatment choice?(1-5)Does it provide support for shared decision making?(1-5)Based on the answers to all of the questions, rate the overall quality of the publication as a source of info about treatment choices?(1-5)1B34412213332223232A54412212111111123B23412212321323124B23312242321223125B24412214333344336A23313311211111127B23344452311212138A34412211111111129A344122123152112310A233122114212211211A233113313111122212A234112124232131213A344112124233111214B234112133332141315A223112112211111216A344112111111111217A223112111211111118A332132111111111219B233122123333131220A233122112211111221B344122134443443322B344233124443243323A433122113211121224A234344423241112325B244122334424442326A222122113211111127A232122111311111228A444122134412121229A233122123111221230B244133334434443431A334122114411411232A334122124441311333B234122123323231234A233122123322331235B234122133343341336A222122123231111237B234112133333341338A233112122212121239B244122134343231340A233122123222221241A233122134213221242A233112124231211243A233112123221111244A233122424231111245A233122124411331246B244112144433341347B244122144443441348A233122124431211249A233122114113132250A233112124411212251A323122131111111152A233122124212241253A232112124311121254A243323433111121255A233122113411111256A233122113212121257A233112134422321258A244554444443321459A244554444241211360A233143112212121261B233133533323231362B345133555454343463B345133455455353464D555344355555555565A555234443441213466A555133542221212367A445133534444222468A233212332222123269A233123333323123270A333133133323123371B344233234344342372A233122122213211273A233122113111111274A233112122111131275A233112122311121276B244133254252242477A234143223242111378A233243113312212379A334132124412322380A234122123312311281B5555552555455545Each DISCERN question is rated on a 5-point scale ranging from no to yes. The rating scale is designed to help identify whether the quality criterion in question is present or has been met by the publication. General guidelines are as follows:5 should be given if the answer to the question is a definite 'yes' - the quality criterion has been completely fulfilledPartially (2-4) should be given if it is felt the publication being considered meets the criterion in question to some extent. How high or low the 'partial' rating is will depends on judgements about the extent of these shortcomings1 should be given if the answer to the question is a definite 'no' - the quality criterion has not been fulfilled at all.References ADDIN EN.REFLIST 1.Australian Commission on Safety and Quality in Health Care. Australian Atlas of Healthcare Variation. Australia: ACSQHC; 2015.2.American Academy of Ophthalmology. Cataract in the Adult Eye Preferred Practice Pattern. San Francisco, United States: Elsevier Inc.; 2016.3.Johnson A, Sandford J. Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home: systematic review. Health Education Research. 2005 August 1, 2005;20(4):423-9.4.Elwyn G, O'Connor A, Bennett C, Newcombe R, Politi M, Durand M-A, et al. Assessing the Quality of Decision Support Technologies Using the International Patient Decision Aid Standards Instrument (IPDASi). PLoS ONE. 2009;4(3):9.5.Patient Information Forum. Making the Case for Information: The evidence for investing in high quality health information for patients and the public. London: PiF, 2013.6.Australian Commission on Safety and Quality in Health Care. Health Literacy: Taking Action for Safety and Quality. Sydney: ACSQHC, 2014.7.Michael J, Aylen T, Ogrin R. Development of a Translation Standard to support the improvement of health literacy and provide consistent high-quality information. Australian Health Review. 2013;37(4):547-51.8.Treadgold P, Grant C. Evidence Review: what does good health information look like? London: Patient Information Forum & Grant Riches Communication Consultants Ltd, 2014 October. Report No.9.DISCERN. Discern Online: Background. United Kingdom: DISCERN; [cited 2017 8 March]; Available from: CE, Ford JE, Sheard CE. Evaluating the reliability of DISCERN: a tool for assessing the quality of written patient information on treatment choices. Patient Education and Counseling. 2002;47(3):273-5.11.Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. Journal of Epidemiology and Community Health. 1999;53(2):105-11.12.Charnock D. The DISCERN Handbook: Quality criteria for consumer health information on treatment choices. Oxon UK,: 1998.13.Da Silva D. Helping people share decision making: A review of evidence considering whether shared decision making is worthwhile. London: The Health Foundation, 2012.14.Desai P, Reidy A, Minassian D, Vafidis G, Bolger J. Gains from cataract surgery: visual function and quality of life. British Journal of Ophthalmology 1996;80:868-73.15.Macular Disease Foundation Australia. Cataracts and macular degeneration. Australia: Macular Disease Foundation Australia; 2016 [cited 2017 15 March]; Available from: Choices. Cataract surgery. United Kingdom: National Health Service; 2016 [cited 2017 20 March]; Available from: 17.Moorfields Eye Hospital NHS Foundation Trust. Cataract service patient information: Cataract. United Kingdom: National Health Service; 2014 [cited 2017 20 March ]; Available from: 18.Healthwise. Cataracts: Should I have surgery? United States: Healthwise; 2017 [cited 2017 22 March]; Available from: 19.Royal College of Opthalmologists. Understanding cataracts. United Kingdom: RCOpth; 2013 [cited 2017 23 March]; Available from: . ................
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