What do patients really want? Patients’ preferences for treatment for angina

OBJECTIVE: To measure preferences for angina treatments among patients admitted from accident and emergency with acute coronary syndrome. BACKGROUND: Evidence suggests variability in treatment allocations amongst certain socio-demographic groups (e.g. related to age and sex), although it is unclear whether this reflects patient choice, as research on patients' treatment preferences is sparse. Given current policy emphasis on 'patient choice', providers need to anticipate patients' preferences to plan appropriate and acceptable health services. DESIGN: Self-administered questionnaire survey. SETTING: In-patients in a UK hospital. PARTICIPANTS: A convenience sample of 53 newly admitted patients with acute coronary syndrome. Exclusion criteria were: a previous cardiologist consultation (including previous revascularization); a clinical judgement of too ill to participate; post-admission death; non-cardiac reasons for chest pain. MAIN OUTCOME MEASURES: Patients' preferences for coronary artery bypass graft (CABG); angioplasty; and two medication alternatives. RESULTS: Angioplasty was the preferred treatment (for 80% of respondents), and CABG was second (most preferred by 19%, but second most preferred for 60%). The two least preferred (and least acceptable) treatments were medications. The majority of patients (83%) would 'choose treatment based on the extent of benefits' and 'accept any treatment, no matter how extreme, to return to health'. There were some differences in preference related to age (>70 years preferred medication to a greater degree than <70 years) and sex (males preferred CABG surgery more than females). CONCLUSIONS: There was general preference for procedural interventions over medication, but most patients would accept any treatment, however extreme, to return to former health. There was some evidence of differences in preferences related to age and sex. Furthermore, most patients preferred to have some input into treatment choice (e.g. nearly half wanted to share decision responsibility with their doctor), with only 4% preferring to leave the decision entirely to their doctor. Given these findings, and past findings that suggest there may be variability in treatment allocation according to certain socio-demographic factors, this study suggests a need to develop and use preference measures, and makes a step towards this.