Is Better Patient Knowledge Associated with Different Treatment Preferences? A Survey of Patients with Stable Coronary Artery Disease
Authors Yuan N, Boscardin C, Lisha NE, Dudley RA, Lin GA
Received 29 October 2020
Accepted for publication 22 December 2020
Published 26 January 2021 Volume 2021:15 Pages 119—126
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Neal Yuan,1 Christy Boscardin,2 Nadra E Lisha,2 R Adams Dudley,3,4 Grace A Lin2
1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; 4School of Public Health, University of Minnesota, Minneapolis, MN, USA
Correspondence: Neal Yuan
Smidt Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Davis 1015, Los Angeles, CA 90048, USA
Background: In stable coronary artery disease (CAD), shared decision-making (SDM) is encouraged when deciding whether to pursue percutaneous coronary intervention (PCI) given similar cardiovascular outcomes between PCI and medical therapy. However, it remains unclear whether improving patient-provider communication and patient knowledge, the main tenets of SDM, changes patient preferences or the treatment chosen. We explored the relationships between patient-provider communication, patient knowledge, patient preferences, and the treatment received.
Methods: We surveyed stable CAD patients referred for elective cardiac catheterization at seven hospitals from 6/2016 to 9/2018. Surveys assessed patient-provider communication, medical knowledge, and preferences for treatment and decision-making. We verified treatments received by chart review. We used linear and logistic regression to examine relationships between patient-provider communication and knowledge, knowledge and preference, and preference and treatment received.
Results: Eighty-seven patients completed the survey. More discussion of the benefits and risks of both medical therapy and PCI associated with higher patient knowledge scores (β=0.28, p< 0.01). Patient knowledge level was not associated with preference for PCI (OR=0.78, 95% CI 0.57– 1.03, p=0.09). Black patients had more than four times the odds of preferring medical therapy to PCI (OR=4.49, 1.22– 18.45, p=0.03). Patients preferring medical therapy were not significantly less likely to receive PCI (OR=0.67, 0.16– 2.52, p=0.57).
Conclusions: While communicating the risks of PCI may improve patient knowledge, this knowledge may not affect patient treatment preferences. Rather, other factors such as race may be significantly more influential on a patient’s treatment preferences. Furthermore, patient preferences are still not well reflected in the treatment received. Improving shared decision-making in stable CAD therefore may require not only increasing patient education but also better understanding and including a patient’s background and pre-existing beliefs.
Keywords: stable coronary artery disease, stable angina, shared decision-making, percutaneous coronary intervention, stent, optimal medical therapy
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