Is Better Patient Knowledge Associated with Different Treatment Preferences? A Survey of Patients with Stable Coronary Artery Disease

Abstract

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.

Keywords:

• stable coronary artery disease
• stable angina
• shared decision-making
• percutaneous coronary intervention
• stent
• optimal medical therapy

Disclosure

Neal Yuan, M.D., Christy Boscardin, Ph.D., Nadra E. Lisha, Ph.D., R. Adams Dudley, M.D., M.B.A., and Grace A. Lin, M.D. report no conflicts of interest.

Additional information

Funding

National Heart, Lung, and Blood Institute R01 HL114918; Agency for Healthcare Research and Quality K08 HS17723. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.