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Decision-making in percutaneous coronary intervention: a survey
Catherine R Rahilly-Tierney1, Ira S Nash
1Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Boston VA Healthcare System, Boston, Massachusetts, USA. Catherine.Rahilly@va.gov
Insights
Physicians desire more collaboration in percutaneous coronary intervention (PCI) decisions. Most non-cardiologists and cardiologists prefer shared decision-making for PCI, highlighting a gap in current collaborative practices.
Area of Science:
- Cardiology
- Medical Decision-Making
- Health Services Research
Background:
- Limited research exists on referring physicians' perceptions of collaboration in percutaneous coronary intervention (PCI) decision-making.
- This study investigates physician perceptions of involvement in PCI decisions referred to a cardiac catheterization lab.
Purpose of the Study:
- To determine referring physicians' perceptions of their involvement in PCI decision-making.
- To assess whether physicians consider current collaboration levels optimal.
Main Methods:
- Anonymous survey distributed to internal medicine faculty at a major academic medical center.
- Survey assessed perceived inclusion in PCI decisions and preference for collaborative decision-making.
Main Results:
- 35% response rate (133/378).
- 89% of non-cardiologists felt PCI decisions were made solely by interventionalists.
- 92% of cardiologists discussed findings with interventionalists before PCI decisions, and 95% preferred a collaborative approach.
Conclusions:
- Both non-cardiologists and cardiologists favor involving referring physicians or non-interventional cardiologists in PCI decisions.
- Cardiologists showed greater alignment between perceived and preferred PCI decision-making processes.
Background:
Few researchers have examined the perceptions of physicians referring cases for angiography regarding the degree to which collaboration occurs during percutaneous coronary intervention (PCI) decision-making. We sought to determine perceptions of physicians concerning their involvement in PCI decisions in cases they had referred to the cardiac catheterization laboratory at a major academic medical center.
Methods:
An anonymous survey was mailed to internal medicine faculty members at a major academic medical center. The survey elicited whether responders perceived that they were included in decision-making regarding PCI, and whether they considered such collaboration to be the best process of decision-making.
Results:
Of the 378 surveys mailed, 35% (133) were returned. Among responding non-cardiologists, 89% indicated that in most cases, PCI decisions were made solely by the interventionalist at the time of the angiogram. Among cardiologists, 92% indicated that they discussed the findings with the interventionalist prior to any PCI decisions. When asked what they considered the best process by which PCI decisions are made, 66% of non-cardiologists answered that they would prefer collaboration between either themselves or a non-interventional cardiologist and the interventionalist. Among cardiologists, 95% agreed that a collaborative approach is best.
Conclusion:
Both non-cardiologists and cardiologists felt that involving another decision-maker, either the referring physician or a non-interventional cardiologist, would be the best way to make PCI decisions. Among cardiologists, there was more concordance between what they believed was the best process for making decisions regarding PCI and what they perceived to be the actual process.
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