How Cardiologists Present the Benefits of Percutaneous Coronary Interventions to Patients With Stable Angina
Population
40 encounters between cardiologists and patients with stable coronary artery disease. Patients were aged 44…
Design
Other
Authors
Discussion
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Member takes
Implication
Frequent overstatement of PCI benefits may undermine informed consent; hypothesis-generating and leaves open effects on decisions pending further study.
Key Points
- To characterize how cardiologists present the risks and benefits of coronary angiography and percutaneous coronary intervention to patients diagnosed with stable coronary artery disease.
- Conducted a qualitative content analysis of 40 audio-recorded clinical encounters retrieved from the Verilogue Point-of-Practice Database between March 2008 and August 2012.
- Evaluated conversations with patients aged 44 to 88 years (median age, 64 years; 25% women; 50% symptomatic for angina) where percutaneous coronary intervention or angiograms were recommended.
- Cardiologists accurately conveyed evidence-based benefits of the procedure in only 5% of encounters, while benefits were explicitly overstated in 13% and implicitly overstated in 35% of discussions.
- Procedural risks were consistently minimized, with decision rationales frequently driven by stress test abnormalities, ongoing symptoms, or cardiologist preference rather than clinical trial evidence.
Structured PICO
P
Population
40 encounters between cardiologists and patients with stable coronary artery disease (CAD). Patients were aged 44 to 88 years (median, 64 years); 25% were women; 50% reported symptoms of angina; and 6% were taking more than 1 medication to treat angina.
I
Intervention
Discussions between patients and cardiologists regarding angiogram and percutaneous coronary intervention (PCI)
O
Outcome
Content of discussions regarding angiogram and PCI for stable CAD, specifically elements affecting patients' understanding of benefits and risks
Cardiologists frequently overstate the benefits of PCI for stable CAD during clinical encounters, which may contribute to patient misunderstanding of the procedure's true evidence-based benefits.
Limitations
- Hypothesis-generating analysis requiring future quantitative studies
Cite This Study
Goff et al. (2014) studied this question.