PCI Choice Decision Aid for Stable Coronary Artery Disease: A Randomized Trial

Area of Science:

• Cardiology
• Medical Decision Making
• Health Informatics

Background:

• Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is often perceived by patients as superior to optimal medical therapy (OMT), despite evidence suggesting similar outcomes for mortality and myocardial infarction.
• A decision aid, PCI Choice, was developed to provide patients with comprehensive information on quality of life and mortality, comparing PCI with OMT versus OMT alone for stable CAD.

Purpose of the Study:

• To evaluate the impact of the PCI Choice decision aid (DA) on patient knowledge and decisional conflict when choosing between PCI and OMT for stable CAD.
• To assess the effect of the DA on objective measures of shared decision-making between patients and clinicians.

Main Methods:

• A randomized trial was conducted comparing the PCI Choice DA with usual care in patients with stable CAD who had the option of PCI.
• Primary outcomes included patient knowledge and decisional conflict. Secondary outcomes focused on shared decision-making.
• The study included 124 patients for final analysis.

Main Results:

• Patients who received the PCI Choice DA demonstrated significantly higher knowledge levels (60%) compared to those receiving usual care (40%; P=0.034).
• Patients using the DA reported feeling more informed (P=0.043).
• However, other measures of decisional quality and clinician-patient shared decision-making engagement did not show significant improvement. Clinicians were observed to use the DA as an educational tool.

Conclusions:

• The PCI Choice DA effectively enhances patient knowledge regarding treatment options for stable CAD.
• Further interventions are necessary to improve clinicians' shared decision-making skills and address knowledge gaps, even when utilizing structured decision aids.