PREPARED Study: A Study of Shared Decision-Making for Coronary Artery Disease

Abstract

Background Guidelines recommend patient engagement in shared decision-making regarding coronary revascularization, but studies demonstrate poor patient understanding of risks, benefits, and alternatives. Effective strategies are needed to integrate informed patient preferences into clinical care, particularly for patients undergoing diagnostic coronary angiography. Methods and Results We developed a web-based decision aid to educate patients and survey their treatment preferences before angiography. We compared knowledge, attitudes, and preferences of 203 patients with and without use of the decision aid. In a pilot cluster-randomized study, cardiologists were assigned to receive versus not receive patient preferences, with subsequent assessment of treatment decisions. The median age of participants was 64 years, 62% were men, 74% were white, and a similar number had acute presentation (49% non-ST-segment-elevation myocardial infarction or unstable angina) and stable presentation (51% stable angina or atypical symptoms). Most patients preferred treatment with percutaneous coronary intervention compared with either medical therapy alone (63% versus 21%) or coronary artery bypass graft surgery (81% versus 7%). The decision aid was associated with improved performance on a 6-item knowledge scale (mean, 2.7 versus 2.2 questions correct; P<0.01) and greater interest in shared decision-making but not an overall change in patient preferences. The pilot cluster-randomized study demonstrated the feasibility of integrating patient preference information into clinical care, although providing preferences to the clinicians did not improve concordance between preference and treatment. Conclusions A web-based decision aid was associated with improved patient knowledge and greater desire to participate in shared decision-making for coronary revascularization. Most patients preferred percutaneous coronary intervention to either medical therapy alone or coronary artery bypass graft surgery. Further investigation is needed to determine the impact of patient preferences on clinical decision-making and outcomes. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02272062.