How cardiologists present the benefits of percutaneous coronary interventions to patients with stable angina: a
Sarah L Goff1, Kathleen M Mazor2, Henry H Ting3
1Department of Internal Medicine, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts2The Center for Quality of Care Research, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts.
Insights
Cardiologists rarely discuss evidence-based benefits of percutaneous coronary interventions (PCI) for stable coronary artery disease (CAD). Overstating benefits and communication style impact patient understanding of PCI risks and benefits.
Area of Science:
- Cardiology
- Health Communication
- Patient Perception
Background:
- Patients with stable coronary artery disease (CAD) often perceive greater benefits from percutaneous coronary interventions (PCI) than clinical trial data suggest.
- The influence of cardiologists' communication on patient perceptions of PCI benefits and risks is not well understood.
Purpose of the Study:
- To analyze the content of discussions between cardiologists and patients regarding angiograms and PCI for stable CAD.
- To identify factors influencing patients' understanding of the benefits and risks associated with these procedures.
Main Methods:
- Qualitative content analysis of 40 patient-cardiologist encounters from the Verilogue Point-of-Practice Database (2008-2012).
- Analysis focused on discussions involving angiograms and PCI for stable CAD in patients aged 44-88.
Main Results:
- Five categories influencing patient understanding were identified: rationale for recommendation, discussion of benefits (accurate: 5%, overstated: 48%), discussion of risks (often minimized), communication style, and patient/family contributions.
- A significant proportion of discussions involved overstatement of benefits, with 35% implicitly and 13% explicitly overstated.
Conclusions:
- Evidence-based benefits of angiograms and PCI for stable CAD are infrequently discussed by cardiologists.
- Overstatement of benefits and communication factors contribute to patient misunderstanding.
- Modifying how cardiologists present risks and benefits may enhance patient comprehension.
Importance:
Patients with stable coronary artery disease (CAD) attribute greater benefit to percutaneous coronary interventions (PCI) than indicated in clinical trials. Little is known about how cardiologists' presentation of the benefits and risks may influence patients' perceptions.
Objectives:
To broadly describe the content of discussions between patients and cardiologists regarding angiogram and PCI for stable CAD, and to describe elements that may affect patients' understanding.
Design, Setting, And Participants:
Qualitative content analysis of encounters between cardiologists and patients with stable CAD who participated in the Verilogue Point-of-Practice Database between March 1, 2008, and August 31, 2012. Transcripts in which angiogram and PCI were discussed were retrieved from the database. Patients were aged 44 to 88 years (median, 64 years); 25% were women; 50% reported symptoms of angina; and 6% were taking more than 1 medication to treat angina.
Main Outcomes And Measures:
Results of conventional and directed qualitative content analysis.
Results:
Forty encounters were analyzed. Five major categories and subcategories of factors that may affect patients' understanding of benefit were identified: (1) rationale for recommending angiogram and PCI (eg, stress test results, symptoms, and cardiologist's preferences); (2) discussion of benefits (eg, accurate discussion of benefit [5%], explicitly overstated benefit [13%], and implicitly overstated benefit [35%]); (3) discussion of risks (eg, minimization of risk); (4) cardiologist's communication style (eg, humor, teach-back, message framing, and failure to respond to patient questions); and (5) patient and family member contributions to the discussion.
Conclusions And Relevance:
Few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. The etiology of patient misunderstanding is likely multifactorial, but if future quantitative studies support the findings of this hypothesis-generating analysis, modifications to cardiologists' approach to describing the risks and benefits of the procedure may improve patient understanding.
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