Truly informed PCI patients

Sometimes a finding doesn’t reach the bar for statistical significance, but that doesn’t mean it isn’t intriguing. Interventional cardiologists might take note of a study on informed decision making that showed them more likely to touch on key elements than general cardiologists.

The results overall are not stellar. Only 3 percent of the cardiologist-patient discussions about angiography and possible PCI included all seven elements deemed necessary for patients to make complex decisions: their role in the decision making; the clinical issue or nature of the discussion; alternatives; pros and cons; uncertainties; an assessment of the patient’s understanding; and the patient’s preference.

The researchers, led by Michael B. Rothberg, MD, MPH, of the Cleveland Clinic, analyzed, recorded and transcribed discussions between six interventional cardiologists, 17 clinical cardiologists and 59 patients. The median length of conversation in these outpatient encounters was 11.8 minutes. All but two cases included a discussion about the clinical issue but only 15 cases had a review of alternatives.

Discussions tended to differ, depending on the specialist. More cases seen by an interventional cardiologist included talk of the pros and cons (83 percent vs. 38 percent for clinical cardiologists) and the patient’s role in decision making (83 percent vs. 49 percent).

The researchers also assessed a more limited definition that included the procedure, alternatives and risk. Using that standard, interventional cardiologists were more likely to touch all the bases than clinical cardiologists (33 percent vs. 11 percent). None of the results were statistically significant.

The bottom line was that informed patients were less likely to opt for angiography and possible PCI. When physicians recommended angiography with the possibility of PCI, 75 percent of the patients followed their advice.

The authors highlighted the disconnect between general cardiologists who counsel patients during the decision process and the operators who later obtain patient consent. “This process is more of a formality because the operators assume the decision has already been made, and patients rarely, if ever, decide to cancel the procedure at this point,” they observed.

Patients sometimes grumble about the repetitive questioning they undergo at hospitals, but those gripes tend to revolve around issues such as insurance type and contact information. Would they see a second conversation before angiography as redundant? Probably not, given the gaps identified by Rothberg and his team.

Would operators view this step as time-consuming and burdensome? Probably, but not if the savings from fewer procedures is funneled into rewards for informing patients. That’s one strategy Rothberg et al propose. It’s food for thought.

Candace Stuart

Editor, Cardiovascular Business