Clinical InvestigationsInterventional CardiologyUnderstanding of the benefits of coronary revascularization procedures among patients who are offered such procedures
Section snippets
Study population
Trained research assistants (RAs) approached individuals scheduled for elective coronary angiography (CATH) at 3 Veterans Health Administration (VHA) hospitals and 1 university hospital from November 1997 through June 1999. All 4 sites had the capacity to perform PCI or CABG. Each VHA site performed 600 to 800 CATHs annually; the university hospital, 5000. All sites were tertiary care hospitals whose medical school affiliation included on-site cardiology fellowships. Two VHA hospitals were
Results
We enrolled 1650 patients. Of these, 633 (38.4%) reported that they had been offered coronary revascularization and answered questionnaire items regarding the expected benefits of the procedure. Most patients were older (mean age 63.8 years), white (89.4%), and male (77.6%), consistent with the population at study hospitals. The population was nearly evenly divided between VHA and university patients. Approximately half (n = 324) were offered CABG. Characteristics of patients offered CABG and
Discussion
In a large population of patients faced with a coronary revascularization decision, we found that many of those patients expected benefits that their physicians did not expect. Both the patients' reports of what the physician told them were the benefits and their beliefs about the procedure's benefits were essentially unrelated to the benefits expected by their physicians. The results suggest that physicians and patients are not communicating successfully about this key decision element.
References (20)
- et al.
What patients recall of the preoperative discussion after retinal detachment surgery
Am J Ophthalmol
(1979) - et al.
Promoting informed choice: transforming health care to dispense knowledge for decision making
Ann Intern Med
(2005) A new model of medical decisions: exploring the limits of shared decision making
Med Decis Making
(2003)Shared medical decision making: problems, process, progress
JAMA
(2004)Comparing benefits and harms: the balance sheet
JAMA
(1990)- et al.
Informed consent for colonoscopy. A prospective study
Arch Intern Med
(1990) - et al.
Factors affecting quality of informed consent
Br Med J
(1993) - et al.
Informed consent in head and neck surgery: how much do patients actually remember?
J Otolaryngol
(1997) - et al.
The right not to know and coronary angiography: is the common law of Australia consistent with patients' wishes?
J Law Med
(2002) Heart disease and stroke statistics—2005 update
(2005)
Cited by (45)
Malpratice claims in cardiology and cardiac surgery: A medico-legal issue
2023, Legal MedicinePatient-Reported Outcomes in Revascularization Decisions for Left-Main Disease: Sharing the EXCELlence <sup>∗</sup>
2017, Journal of the American College of CardiologyExploring expectations and needs of patients undergoing angioplasty
2016, Journal of Vascular NursingInformed consent for cardiac procedures: Deficiencies in patient comprehension with current methods
2014, Annals of Thoracic SurgeryCitation Excerpt :The comparatively thorough and consistently delivered scripted verbal consent used, for example, may represent a falsely high baseline comparator that is not reflective of more commonplace practices. Consistent with this supposition, patients in both groups reported great satisfaction with the consent process and with the physicians and practitioners rendering care, in contrast to the relatively poor satisfaction levels previously reported in the literature [7, 12, 15, 20]. These considerations highlight further opportunity for improving the informed consent processes through careful adherence to standards of evidence-based decision-making and information delivery.
Understanding of informed consent by parents of children enrolled in a genetic biobank
2014, Genetics in MedicineComprehensive Implementation of Shared Decision Making in a Neuromedical Center Using the SHARE TO CARE Program
2023, Patient Preference and Adherence