Quantifying Patient-Physician Communication and Perceptions of Risk During Admissions for Possible Acute Coronary...

Area of Science:

• Emergency Medicine
• Cardiology
• Health Communication

Background:

• Disposition decisions for patients with possible acute coronary syndrome (ACS) in the emergency department (ED) are primarily based on perceived short-term risks.
• Effective communication regarding these risks is crucial for appropriate patient management and disposition.

Purpose of the Study:

• To evaluate the communication between patients and physicians regarding the risks associated with possible acute coronary syndrome (ACS).
• To ascertain the content of discussions surrounding disposition decisions for patients presenting with chest pain.

Main Methods:

• Matched-pair surveys were administered to patients admitted for possible ACS and their physicians in two academic, inner-city EDs.
• Surveys queried perceived and communicated risk estimates of myocardial infarction and purpose of admission after the disposition conversation.
• Patients with diagnostic ECG or troponin values for ACS were excluded; primary outcome was patient-physician risk estimate agreement within 10%.

Main Results:

• Patient-physician risk agreement within 10% occurred in only 36% of cases.
• Patients' median estimate of short-term myocardial infarction risk was 8%, while physicians' was 5%.
• Patients significantly overestimated the mortality risk of myocardial infarction at home (80%) compared to physicians (15%).

Conclusions:

• The study demonstrates poor communication regarding ACS risks, with patients overestimating both the likelihood of myocardial infarction and the benefits of hospital admission.
• Findings suggest that communication surrounding disposition decisions for chest pain patients can be ineffective or misleading.
• Improved patient-physician risk communication is needed for better disposition decision-making in the ED.