Prior studies suggest patients are often misinformed about the anticipated benefits of PCI for stable coronary disease.\u00a0 However, there is little data on patient-provider discussions that may explain discrepancies in patient understanding about the limited benefits of PCI in this setting.\u00a0 \u00a0Rothberg and colleagues performed a cross-sectional analysis of 59 conversations between providers and patients about PCI.\u00a0 The conversations included 23 cardiologists (all male, 6 interventionalists, median 19 years experience) representing all regions of the United States from 2008 to 2012.\u00a0 Conversations were analyzed for discussion of 7 elements central to shared-decision making: (1) the patient\u2019s role in decision making, (2) the clinical issue or nature of the decision, (3) alternatives to PCI, (4) pros and cons of the alternatives, (5) the uncertainties associated with the decision, (6) assessment of the patient\u2019s understanding, and<\/p>\n
(7) exploration of patient preference.\u00a0 Only 2 conversations (3%) included all 7 elements of shared-decision making.\u00a0 Patients were less likely to choose PCI if the conversation included discussion of uncertainty (odds ratio [OR], 20.5; 95% confidence interval [CI], 2.3-204.9), exploration of alternatives (OR, 9.5; 95% CI, 2.5-36.5) and discussion of patient preferences (OR, 4.8; 95% CI, 1.2-19.4).\u00a0 Interventional cardiologists more often discussed the pros and cons of PCI, alternatives, and the patient\u2019s role in decision-making. More informed patients (as assessed by the number of shared-decision making elements discussed) were less likely to choose angiography and possible PCI (OR per additional element, 3.2; 95% CI, 1.4-7.1; P = .005)<\/p>\n
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