Developing an Individualized Patient Decision Aid for Chronic Coronary Disease Based on the ISCHEMIA Trial: A...

Area of Science:

• Cardiology
• Medical Decision Making
• Patient Education

Background:

• Chronic coronary disease (CCD) management involves preference-sensitive decisions between invasive and conservative approaches.
• Shared decision-making is crucial, but communicating population-averaged trial outcomes to individual patients is challenging.
• Existing clinical trial data often fails to represent individual patient outcomes for CCD management.

Purpose of the Study:

• To develop a patient decision aid (PDA) for CCD.
• To provide patient-specific outcome estimates for invasive versus conservative management.
• To base the PDA on data from the ISCHEMIA trial.

Main Methods:

• A multiphase mixed-methods study involving focus groups with patients, caregivers, and clinicians.
• Elicitation of patient priorities for outcomes and treatment preferences.
• Development and iterative refinement of the PDA using participant feedback.

Main Results:

• Participants prioritized survival and quality of life, followed by physical functioning and symptoms.
• Patients valued shared decision-making but often deferred to clinicians.
• Simple visualizations like a speedometer were preferred for representing outcomes.
• Patients preferred using the PDA collaboratively with a clinician.

Conclusions:

• A novel, patient-centered PDA for CCD was developed.
• The PDA offers patient-specific outcomes, enhancing shared decision-making.
• This approach facilitates the translation of clinical trial results to individual patient care.