Survey: most think it will cure their heart disease
Informed consent isn't getting the job done for percutaneous coronary intervention (PCI), a survey suggested.
On the whole, the information given during this process is not understood or remembered by most patients, according to more than half of cardiologists and patients surveyed by Felicity Astin, PhD, of the University of Huddersfield, England, and colleagues.
Notably, 60% of patients mistakenly believed that PCI is a cure for coronary heart disease, the authors reported online in the European Journal of Cardiovascular Nursing.
"We recommend that future research should identify interventions designed to correct this misconception within a revised informed consent discussion, which is the final step in a supported decision-making process. A clause on the consent form could be added that explains that PCI is not curative but that secondary prevention offers patients a way to control disease progression," according to Astin's group.
The ISCHEMIA trial recently affirmed that early revascularization does not help outcomes for people with stable, moderate-to-severe ischemic heart disease.
It is important that doctors get enough time to go through informed consent with their patients, the authors said.
Greater involvement of family or friends may also help patient engagement, they added, given that 47% of patients surveyed said they would have liked a family member with them when their treatment was explained during the informed consent process.
The survey, done in England, included 118 cardiologist members of the British Cardiovascular Intervention Society and 326 patients who had received elective or acute PCI, excluding primary PCI due to a different informed consent process.
Almost all those surveyed agreed that informed consent provides information on the risks and benefits of this procedure, with just under three-quarters also saying that it presents alternative treatment options for patients.
Over 60% of patients said they depended on their doctor to make the decision of whether to undergo PCI, whereas just over a quarter of cardiologists said that their patients let them decide for them.
"Poor levels of patient comprehension and recall about the risks and benefits of PCI treatment have been reported in other international studies dating back over 20 years; our study adds an English perspective to these," Astin and colleagues wrote.
"There appears to have been limited progress in addressing this challenge, but the implementation of educational interventions and decision aids offers two approaches to improve patient knowledge and recall which will optimise the wider decision-making process that overlaps with PCI informed consent," they continued.
The authors cautioned that their study was limited by the low 16% response rate by cardiologists invited to participate -- compared with 82% among patients -- raising the possibility of non-response bias.
"Health literacy is a neglected issue," Astin nevertheless emphasized in a press release. "Leaflets should be in plain language. In addition, clinicians should ask patients if they need help reading or understanding health information. Patients will not volunteer that they can't read."
Astin's team had no disclosures.
European Journal of Cardiovascular Nursing
Source Reference: Astin F, et al "Cardiologists' and patients' views about the informed consent process and their understanding of the anticipated treatment benefits of coronary angioplasty: a survey study" Eur J Cardiovasc Nurs 2019; DOI: 10.1177/1474515119879050.
Read the original article on Medpage Today: Do Patients Really Understand PCI?