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Discrepancies found between physician and patient expectations of PCI
Fernandez A. Ann Intern Med. 2010;153:342-343.
Rothberg M. Ann Intern Med. 2010;153:307-313.
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Substantial differences exist between patients’ and physicians’ perceptions of percutaneous coronary intervention, including most patients who expect the procedure to lower their risk for MI, results from a new study suggest.
The study included 153 patients who consented to elective coronary catheterization, 10 interventional cardiologists and 17 referring cardiologists. Of the patients, 68% had angina, 42% activity-limiting angina, 77% had a positive stress test and 29% had previous MI. Researchers measured patients’ and cardiologists’ perception about the benefits of PCI.
They reporte that nearly three-quarters of patients said they believed that without PCI, they would likely have MI within 5 years. Further, 88% of patients expected PCI to lower MI risk, with patients significantly more likely than physicians to believe that PCI would prevent MI (prevalence ratio, 4.25; 95% CI, 2.31-7.79) or fatal MI (prevalence ratio, 4.83; 95% CI, 2.23-10.46).
Among the study limitations were the small population size, single-center design and limited availability of information concerning pre-catheterization counseling.
“Most patients undergoing the procedure still believe that PCI will prevent infarction or death,” the researchers concluded. “Further efforts should be directed toward improving communication of medical evidence to help patients make informed decisions about this common procedure.”
In an accompanying editorial, Alicia Fernandez, MD, associate professor of clinical medicine with the University of San Francisco, said most clinicians will not find these results surprising because patients commonly overestimate or misunderstand the benefits of treatment.
“That the processes we typically use fail to accurately convey information on expected benefits is particularly distressing for stable CAD, a model condition for ‘preference-sensitive decision-making,’” she said, adding that informed consent requires physicians to do more than tell their patients about the risks of the offered treatments. “We need to make sure our patients also fully understand the anticipated benefits.”
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