Ophthalmologists' Perceptions of the Impact of Patient Mental Status on Clinical Decision-Making: A Cross-Sectional...

To investigate ophthalmologists' perceptions of how patients' mental status influences ophthalmic clinical practice and to identify ocular diseases perceived by ophthalmologists as having the greatest psychological impact.

This exploratory cross-sectional questionnaire survey included 61 ophthalmologists from a regional ophthalmologists' association in Japan (41 men and 20 women; mean clinical experience, 26 ± 14 years). Participants rated the extent to which they considered patients' mental status during treatment selection using a 10-point scale (1 = not considered at all; 10 = maximal consideration). The survey assessed perceived treatment-related changes in patient mental status, clinical domains perceived to be influenced by mental status, experiences of perceived clinical impact due to insufficient psychological consideration, and ocular diseases perceived to impose the greatest psychological burden. Multivariable logistic regression was used to identify factors associated with reporting perceived clinical impact.

The mean mental health attention score was 7.0 ± 1.8 (range, 2-10). Fifty-five physicians (90.2%) reported experiencing treatment-related changes in patients' mental status. The clinical domains most frequently selected as being influenced by patient mental status were disease explanation, healthcare-seeking behavior, surgical decision-making, and medication management. Thirty-two physicians (52.5%) reported that insufficient attention to patient mental health had affected clinical care. Higher mental health attention scores were independently associated with reporting perceived clinical impact (odds ratio, 1.45 per 1-point increase; 95% confidence interval, 1.05-2.01; p = 0.02). Glaucoma was most frequently ranked as the ocular diseases perceived by ophthalmologists as being associated with the greatest psychological burden, followed by retinitis pigmentosa.

Ophthalmologists in this sample perceived patient mental status as relevant to clinical practice, particularly in chronic progressive diseases such as glaucoma and inherited retinal disorders. Because this survey assessed physician perceptions rather than patient-reported mental health or objective clinical outcomes, future studies incorporating validated mental health instruments, patient-reported outcomes, and objective clinical endpoints are needed.