Patient Preference and Adherence (Jan 2021)
Is Better Patient Knowledge Associated with Different Treatment Preferences? A Survey of Patients with Stable Coronary Artery Disease
Abstract
Neal Yuan,1 Christy Boscardin,2 Nadra E Lisha,2 R Adams Dudley,3,4 Grace A Lin2 1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; 4School of Public Health, University of Minnesota, Minneapolis, MN, USACorrespondence: Neal YuanSmidt Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Davis 1015, Los Angeles, CA 90048, USAEmail [email protected]: 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
