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Is Better Patient Knowledge Associated with Different Treatment Preferences? A Survey of Patients with Stable
Neal Yuan1, Christy Boscardin2, Nadra E Lisha2
1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Insights
Improving shared decision-making in coronary artery disease (CAD) requires more than patient education. Patient knowledge about percutaneous coronary intervention (PCI) did not influence treatment preferences, while race did. Patient preferences were also not consistently reflected in treatment decisions.
Area of Science:
- Cardiology
- Health Services Research
- Patient-Centered Care
Background:
- Shared decision-making (SDM) is recommended for stable coronary artery disease (CAD) patients deciding between percutaneous coronary intervention (PCI) and medical therapy due to similar outcomes.
- The impact of enhanced patient-provider communication and knowledge on patient preferences and treatment choices in stable CAD remains unclear.
Purpose of the Study:
- To explore the relationships between patient-provider communication, patient knowledge, patient preferences, and the actual treatment received in stable CAD patients.
- To determine if improving patient knowledge through communication influences treatment preferences and decisions.
Main Methods:
- A survey of 87 stable CAD patients referred for elective cardiac catheterization was conducted.
- Surveys assessed patient-provider communication, medical knowledge, and treatment preferences; treatment received was verified via chart review.
- Linear and logistic regression analyses examined the associations between communication, knowledge, preference, and treatment received.
Main Results:
- Increased discussion of PCI and medical therapy benefits/risks correlated with higher patient knowledge scores (β=0.28, p<0.01).
- Patient knowledge did not significantly influence preference for PCI (OR=0.78, p=0.09).
- Black patients were over four times more likely to prefer medical therapy over PCI (OR=4.49, p=0.03), and patient preferences did not significantly predict PCI receipt (OR=0.67, p=0.57).
Conclusions:
- Enhanced communication may improve patient knowledge but not necessarily alter treatment preferences in stable CAD.
- Patient background factors, such as race, appear more influential on treatment preferences than medical knowledge.
- Current shared decision-making practices may not adequately incorporate patient preferences, necessitating a deeper understanding of patient backgrounds and beliefs.
Background:
In stable coronary artery disease (CAD), shared decision-making (SDM) is encouraged when deciding whether to pursue percutaneous coronary intervention (PCI) given similar cardiovascular outcomes between PCI and medical therapy. However, it remains unclear whether improving patient-provider communication and patient knowledge, the main tenets of SDM, changes patient preferences or the treatment chosen. We explored the relationships between patient-provider communication, patient knowledge, patient preferences, and the treatment received.
Methods:
We surveyed stable CAD patients referred for elective cardiac catheterization at seven hospitals from 6/2016 to 9/2018. Surveys assessed patient-provider communication, medical knowledge, and preferences for treatment and decision-making. We verified treatments received by chart review. We used linear and logistic regression to examine relationships between patient-provider communication and knowledge, knowledge and preference, and preference and treatment received.
Results:
Eighty-seven patients completed the survey. More discussion of the benefits and risks of both medical therapy and PCI associated with higher patient knowledge scores (β=0.28, p<0.01). Patient knowledge level was not associated with preference for PCI (OR=0.78, 95% CI 0.57-1.03, p=0.09). Black patients had more than four times the odds of preferring medical therapy to PCI (OR=4.49, 1.22-18.45, p=0.03). Patients preferring medical therapy were not significantly less likely to receive PCI (OR=0.67, 0.16-2.52, p=0.57).
Conclusions:
While communicating the risks of PCI may improve patient knowledge, this knowledge may not affect patient treatment preferences. Rather, other factors such as race may be significantly more influential on a patient's treatment preferences. Furthermore, patient preferences are still not well reflected in the treatment received. Improving shared decision-making in stable CAD therefore may require not only increasing patient education but also better understanding and including a patient's background and pre-existing beliefs.
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