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Developing and Testing a Personalized, Evidence-Based, Shared Decision-Making Tool for Stent Selection in

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Shared decision-making tools for drug-eluting stents improve patient knowledge but require coaching. The tool alone did not impact stent selection, indicating potential physician-level barriers to shared decision-making.

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Area of Science:

  • Cardiology
  • Health Services Research
  • Patient Decision Making

Background:

  • Drug-eluting stents (DES) reduce restenosis but necessitate prolonged dual antiplatelet therapy, increasing bleeding risk and costs.
  • Physician discussion of stent options with patients is infrequent, despite high DES utilization.
  • Shared decision-making (SDM) aims to improve patient involvement in treatment choices.

Purpose of the Study:

  • To evaluate the effectiveness of an individualized shared decision-making (SDM) tool for coronary stent selection.
  • To assess the impact of the SDM tool, with and without decision coaching, on patient knowledge, participation, and stent preference.

Main Methods:

  • An SDM tool for stent selection was implemented in two US hospitals.
  • Patients received the SDM tool with or without decision coaching from a nurse.
  • Patient knowledge, SDM participation, stent preference, and stent selection concordance were assessed via interviews.

Main Results:

  • SDM tool with coaching significantly improved patient knowledge (mean difference +1.8) and SDM participation (OR=2.96).
  • Patients receiving coaching were more likely to state a stent preference (OR=2.00).
  • The SDM tool, with or without coaching, did not impact stent selection or the concordance between patient preference and received stent.

Conclusions:

  • An SDM tool enhances patient knowledge and participation in stent selection when combined with decision coaching.
  • Physician-level barriers may hinder the impact of SDM tools on actual stent selection and preference concordance.
  • Further research is needed to address systemic barriers to effective SDM in percutaneous coronary intervention.