PCI Choice Decision Aid for Stable Coronary Artery Disease

Abstract

Although it is not clear whether this is primarily because of patient or physician preference, there is consistency in patient misperception of the benefit of PCI. 8 The treatment of stable CAD represents a preferencesensitive decision with comparable, alternative treatments. Shared decision making (SDM), as a "process of interacting with patients who wish to be involved in arriving at an informed, values-based choice among…medically reasonable alternatives," 9 offers a unique approach to healthcare delivery of patients with stable CAD. Decision aids may help Background-Percutaneous coronary intervention (PCI) for stable coronary artery disease does not reduce the risk of death and myocardial infarction compared with optimal medical therapy (OMT), but many patients think otherwise. PCI Choice, a decision aid (DA), was designed for use during the clinical visit and includes information on quality of life and mortality outcomes for PCI with OMT versus OMT alone for stable coronary artery disease. Methods and Results-We conducted a randomized trial to assess the impact of the PCI Choice DA compared with usual care when there is a choice between PCI and optimal medical therapy. Primary outcomes were patient knowledge and decisional conflict, and the secondary outcome was an objective measure of shared decision making. A total of 124 patients were eligible for final analysis. Knowledge was higher among patients receiving the DA compared with usual care (60% DA; 40% usual care; P=0.034), and patients felt more informed (P=0.043). Other measures of decisional quality were not improved, and engagement of the patient by the clinician in shared decision making did not change with use of the DA. There was evidence that clinicians used the DA as an educational tool. Conclusions-The PCI Choice DA improved patient knowledge but did not significantly impact decisional quality. Further work is needed to effectively address clinician knowledge gaps in shared decision-making skills, even in the context of carefully designed DAs. Clinical Trial Registration-URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01771536.(Circ Cardiovasc Qual Outcomes. 2016;9:767-776.

Decision aids that facilitate elements of shared decision making in chronic illnesses: a systematic review

“… ? ↑ • • ↔ • Coylewright et al 2016 [ 40 ] • ? ✔ ✔ ✔ ✔ • ↔ ↔ • • McAlister et al 2005 [ 41 ] ✔ ✔ ✔ ✔ ✔ ✔ • • ↑ • • Respiratory diseases Gagné et al 2017 [ 29 ] ✔ ?…”

Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

“…Twenty-five papers met the inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials (online supplementary file 1). 13–37 One study was excluded because it had no comparator group without decision aid 38. There were three nested qualitative studies and nine RCTs included in our review that were not included in the Cochrane review, the majority of which were published after April 2015, the date of the literature search for the Cochrane review.…”

Fostering Choice Awareness for Shared Decision Making: A Secondary Analysis of Video-Recorded Clinical Encounters

“…Most of these trials included patients outside the referral practice of the Mayo Clinic and involved primary and specialty care, physicians and nurses, and emergency and ambulatory settings (Table 1). 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 These multicenter trials compared usual care (with clinicians conducting the encounter as they saw fit) with the use of a within-encounter conversation aid, an SDM tool designed to convey evidence and promote SDM during the encounter. Participating clinicians received training on how to use the conversation aid before their first use, in the form of either a brief (<10 minutes) demonstration or a video-clip or storyboard 20 …”