Shared decision making in patients with stable coronary artery disease: PCI choice

PLoS One. 2012;7(11):e49827. doi: 10.1371/journal.pone.0049827. Epub 2012 Nov 30.

Abstract

Background: Percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) are comparable, alternative therapies for many patients with stable angina; however, patients may have misconceptions regarding the impact of PCI on risk of death and myocardial infarction (MI) in stable coronary artery disease (CAD).

Methods and results: We designed and developed a patient-centered decision aid (PCI Choice) to promote shared decision making for patients with stable CAD. The estimated benefits and risks of PCI+OMT as compared to OMT were displayed in a decision aid using pictographs with natural frequencies and text. We engaged patients, clinicians, health service researchers, and designers with over 20 successive iterations of the decision aid, which were field tested during real-world clinical encounters involving clinicians and patients. The decision aid is intended to facilitate knowledge transfer, deliberation based on patient values and preferences, and shared decision making.

Conclusions: We describe the methods and outcomes of the design and development of a decision aid (PCI Choice) to promote shared decision making between clinicians and patients regarding the choice of PCI+OMT vs. OMT for treatment of stable CAD. We will evaluate the impact of PCI Choice on patient knowledge, decisional conflict, participation in decision-making, and treatment choice in an upcoming randomized trial.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angina, Stable / psychology
  • Angina, Stable / therapy*
  • Cardiotonic Agents / pharmacology
  • Cardiotonic Agents / therapeutic use*
  • Choice Behavior
  • Coronary Artery Disease / psychology
  • Coronary Artery Disease / therapy*
  • Decision Making*
  • Decision Support Techniques
  • Decision Trees
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Myocardial Infarction / prevention & control
  • Myocardial Infarction / psychology
  • Myocardial Infarction / therapy*
  • Percutaneous Coronary Intervention / education
  • Percutaneous Coronary Intervention / statistics & numerical data*
  • Randomized Controlled Trials as Topic

Substances

  • Cardiotonic Agents

Grants and funding

Dr. Ting was awarded a Program Development Grant from the Jeanne Sullivan Development fund to study shared decision making in coronary artery disease. This funding source had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.