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Variation in patients' perceptions of elective percutaneous coronary intervention in stable coronary artery disease:
Faraz Kureshi1, Philip G Jones2, Donna M Buchanan3
1Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA University of Missouri- Kansas City, Kansas City, MO, USA kureshif@umkc.edu.
Insights
Patients undergoing elective percutaneous coronary intervention often misunderstand its benefits, with understanding varying significantly by hospital. Interventions are needed to improve patient comprehension and informed consent processes.
Area of Science:
- Cardiology
- Health Services Research
- Patient Education
Background:
- Elective percutaneous coronary intervention (PCI) is a common procedure for stable coronary artery disease.
- Patient understanding of the benefits and urgency of PCI is crucial for informed decision-making.
- Variability in patient perceptions and informed consent processes across healthcare settings is a concern.
Purpose of the Study:
- To assess patient perceptions of the urgency and benefits of elective PCI.
- To examine how these perceptions vary across different healthcare centers and providers.
- To identify potential areas for improving patient understanding and informed consent.
Main Methods:
- Cross-sectional study involving 991 patients with stable coronary artery disease.
- Interviews were conducted to assess patients' perceptions of PCI benefits and urgency.
- Multilevel hierarchical logistic regression models were used to analyze variations across centers and operators.
Main Results:
- The primary perceived benefits of PCI were life extension (90%) and prevention of heart attacks (88%).
- Only two-thirds of patients identified symptom improvement as a benefit, and 1% considered it the sole benefit.
- Significant variation in patient perceptions of PCI benefits was observed across hospitals, but not among operators within hospitals.
Conclusions:
- Patients demonstrate a poor understanding of the benefits of elective PCI, with substantial inter-site variability.
- Inconsistent informed consent procedures across hospitals contribute to this lack of comprehension.
- Hospital-level interventions targeting informed consent processes are recommended to enhance patient understanding of PCI benefits.
Objectives:
To assess the perceptions of patients with stable coronary artery disease of the urgency and benefits of elective percutaneous coronary intervention and to examine how they vary across centers and by providers.
Design:
Cross sectional study.
Setting:
10 US academic and community hospitals performing percutaneous coronary interventions between 2009 and 2011.
Participants:
991 patients with stable coronary artery disease undergoing elective percutaneous coronary intervention.
Main Outcome Measures:
Patients' perceptions of the urgency and benefits of percutaneous coronary intervention, assessed by interview. Multilevel hierarchical logistic regression models examined the variation in patients' understanding across centers and operators after adjusting for patient characteristics, using median odds ratios.
Results:
The most common reported benefits from percutaneous coronary intervention were to extend life (90%, n=892; site range 80-97%) and to prevent future heart attacks (88%, n=872; site range 79-97%). Although nearly two thirds of patients (n=661) reported improvement of symptoms as a benefit of percutaneous coronary intervention (site range 52-87%), only 1% (n=9) identified this as the only benefit. Substantial variability was noted in the ways informed consent was obtained at each site. After adjusting for patient and operator characteristics, the median odds ratios showed significant variation in patients' perceptions of percutaneous coronary intervention across sites (range 1.4-3.1) but not across operators within a site.
Conclusion:
Patients have a poor understanding of the benefits of elective percutaneous coronary intervention, with significant variation across sites. No sites had a high proportion of patients accurately understanding the benefits. Coupled with the wide variability in the ways in which hospitals obtain informed consent, these findings suggest that hospital level interventions into the structure and processes of obtaining informed consent for percutaneous coronary intervention might improve patient comprehension and understanding.
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