title: Development of a patient decision aid for people with refractory angina: protocol for a three-phase pilot study.
abstract: BACKGROUND
  Refractory angina is a severe chronic disease, defined as angina which cannot be controlled by usual treatments for heart disease. This disease is frightening, debilitating, and difficult to manage. Many people suffering refractory have inadequate pain relief, continually revisit emergency departments for help, undergo repeated cardiac investigations, and struggle with obtaining appropriate care. There is no clear framework to help people understand the risks and benefits of available treatment options in Canada. Some treatments for refractory angina are invasive, while others are not covered by provincial health insurance plans. Effective care for refractory angina sufferers in Canada is critically underdeveloped; it is important that healthcare professionals and refractory angina sufferers alike understand the treatment options and their implications. This proposal builds on the recent Canadian practice guidelines for the management of refractory angina. We propose to develop a decision support tool in order to help people suffering from refractory angina make well-informed decisions about their healthcare and reduce their uncertainty about treatment options.
  
  
  METHODS
  This project will be conducted in three phases: a) development of the support tool with input from clinical experts, the Canadian refractory angina guidelines, and people living with refractory angina, b) pilot testing of the usability of the tool, and c) formal preliminary evaluation of the effectiveness of the support tool to help people make informed decisions about treatment options.
  
  
  CONCLUSIONS
  A decision support tool for refractory angina is needed and the available data suggest that by developing such a tool, we may be able to help refractory angina sufferers better understand their condition and the effectiveness of available treatment options (in their respective clinical settings) as well as their implications (e.g. risks vs. benefits). By virtue of this tool, we may also be able to facilitate identification and inclusion of patients' values and preferences in the decision making process. This is particularly important as refractory angina is an intractable condition, necessitating that the selected course of treatment be lifelong. This study will yield a much needed patient decision aid for people living with refractory angina and pilot data to support a subsequent effectiveness study.
authors.affiliation: Faculty of Health Sciences, McMaster University, 1280 Main St, W, Hamilton ON, L8N 3Z5, Canada. mmcgill@mcmaster.ca.
authors.forename: Michael Hugh
authors.initials: MH
authors.lastname: McGillion
authors.forename: Sandra Lee
authors.initials: SL
authors.lastname: Carroll
authors.forename: Kelly
authors.initials: K
authors.lastname: Metcalfe
authors.forename: Heather Mary
authors.initials: HM
authors.lastname: Arthur
authors.forename: Joseph Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Robert
authors.initials: R
authors.lastname: McKelvie
authors.forename: Etienne Marc
authors.initials: EM
authors.lastname: Jolicoeur
authors.forename: Marie-Gabrielle
authors.initials: MG
authors.lastname: Lessard
authors.forename: James
authors.initials: J
authors.lastname: Stone
authors.forename: Nelson
authors.initials: N
authors.lastname: Svorkdal
authors.forename: John George
authors.initials: JG
authors.lastname: Hanlon
authors.forename: Ada
authors.initials: A
authors.lastname: Andrade
authors.forename: Joel
authors.initials: J
authors.lastname: Niznick
authors.forename: Louise
authors.initials: L
authors.lastname: Malysh
authors.forename: William
authors.initials: W
authors.lastname: McDonald
authors.forename: Bonnie
authors.initials: B
authors.lastname: Stevens
authors.forename: Peter
authors.initials: P
authors.lastname: Coyte
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
mesh_terms: D000787:Angina Pectoris / Q000523:psychology / Q000628:therapy*; D002170:Canada; D003657:Decision Making; D003661:Decision Support Techniques; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010865:Pilot Projects; D011795:Surveys and Questionnaires