Many heart patients overestimate the benefits of PCI
A study published in the European Journal of Cardiovascular Nursing Nov. 28 found that nearly half of heart patients undergoing percutaneous coronary intervention (PCI) admit to not understanding or remembering the bulk of the informed consent process, leaving them without a clear picture of the procedure and its potential benefits.
Informed consent—the legally and ethically mandated process of providing a patient with details about the risks and benefits of their impending procedure—is critical to quality patient care, according to the study’s authors, a team led by University of Huddersfield professor Felicity Astin. Patients should receive enough information to make an informed decision about the course of their care, but not so much that they feel swayed one way or the other.
Astin and her team asked a group of patients about the informed consent process, including individuals treated with either elective or urgent PCI. Patients who underwent emergency PCI weren’t included in the analysis, since that’s a unique situation where speed takes precedence over a thorough conversation.
The researchers found that 60% of patients with coronary heart disease who underwent elective PCI to unblock an artery falsely believed the procedure would cure their CHD. Ninety-five percent said they thought it would reduce their risk of a future heart attack; 91% said they expected PCI to increase their life span.
“These beliefs do not align with trial evidence, which shows that elective PCI is predominantly for relief of symptoms,” Astin said in a statement.
More than 40% of patients surveyed admitted they didn’t understand or remember the information they received from their physicians during the informed consent process, but that wasn’t the biggest shock to Astin. She said patients often receive all the information about an upcoming procedure at once, leaving them feeling “overloaded, which contributes to forgetting or not comprehending what they hear.”
Almost half of patients in the study—47%—said they would have liked to have a family member present during the informed consent process. Nearly one-third said they needed at least some degree of help to understand written information pertaining to their health.
“Health literacy is a neglected issue,” Astin said, arguing that healthcare services should be reconfigured to allow plenty of time for informed consent. “Leaflets should be in plain language. In addition, clinicians should ask patients if they need help reading or understanding health information. Patients will not volunteer that they can’t read.”
She said cardiologists and nurses might benefit from “teach-back” training, or the practice of teaching smaller, more digestible pieces of information over time and asking the patient to explain what they learned in their own words.
“The emphasis is on being a good teacher, not testing the patient and making them feel ashamed,” Astin said. “But staff can only do this if they have the time, which is why patient pathways need to be configured.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.