Jacob A. Doll|W. Schuyler Jones|Yuliya Lokhnygina|Sara Culpepper|Robin L. Parks|Christy Calhoun|David H. Au|Manesh R. Patel
PREPARED Study: A Study of Shared Decision-Making for Coronary Artery Disease
VA Puget Sound Health Care System|University of Washington|Duke University|Clinical Research Institute|Duke University|Clinical Research Institute|Healthwise|Healthwise|VA Puget Sound Health Care System|Duke University|Clinical Research Institute
background guidelines recommend patient engagement shared decisionmaking regarding coronary revascularization studies demonstrate poor patient understanding risks benefits alternatives effective strategies needed integrate informed patient preferences clinical care particularly patients undergoing diagnostic coronary angiography methods results developed webbased decision aid educate patients survey treatment preferences angiography compared knowledge attitudes preferences 203 patients without use decision aid pilot clusterrandomized study cardiologists assigned receive versus receive patient preferences subsequent assessment treatment decisions median age participants 64 years 62 men 74 white similar number acute presentation 49 nonstsegmentelevation myocardial infarction unstable angina stable presentation 51 stable angina atypical symptoms patients preferred treatment percutaneous coronary intervention compared either medical therapy alone 63 versus 21 coronary artery bypass graft surgery 81 versus 7 decision aid associated improved performance 6item knowledge scale mean 27 versus 22 questions correct p001 greater interest shared decisionmaking overall change patient preferences pilot clusterrandomized study demonstrated feasibility integrating patient preference information clinical care although providing preferences clinicians improve concordance preference treatment conclusions webbased decision aid associated improved patient knowledge greater desire participate shared decisionmaking coronary revascularization patients preferred percutaneous coronary intervention either medical therapy alone coronary artery bypass graft surgery investigation needed determine impact patient preferences clinical decisionmaking outcomes clinical trial registration url httpswwwclinicaltrialsgov unique identifier nct02272062