title: Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease.
abstract: OBJECTIVE
  Patients with stable coronary disease undergoing percutaneous coronary intervention (PCI) are frequently misinformed about the benefits of PCI. Little is known about the quality of decision making before angiography and possible PCI.
  
  
  OBJECTIVE
  To assess the quality of informed decision making and its association with patient decisions.
  
  
  METHODS
  We performed a cross-sectional analysis of recorded conversations between August 1, 2008, and August 31, 2012, among adults with known or suspected stable coronary disease at outpatient cardiology practices.
  
  
  METHODS
  Presence of 7 elements of informed decision making and the decision to undergo angiography and possible PCI.
  
  
  RESULTS
  Of 59 conversations conducted by 23 cardiologists, 2 (3%) included all 7 elements of informed decision making; 8 (14%) met a more limited definition of procedure, alternatives, and risks. Specific elements significantly associated with not choosing angiography and possible PCI included discussion of uncertainty (odds ratio [OR], 20.5; 95% CI, 2.3-204.9), patient's role (OR, 5.3; 95% CI, 1.3-21.3), exploration of alternatives (OR, 9.5; 95% CI, 2.5-36.5), and exploration of patient preference (OR, 4.8; 95% CI, 1.2-19.4). Neither the presence of angina nor severity of symptoms was associated with choosing angiography and possible PCI. In a multivariable analysis using the total number of elements as a predictor, better informed patients were less likely to choose angiography and possible PCI (OR per additional element, 3.2; 95% CI, 1.4-7.1; P = .005).
  
  
  CONCLUSIONS
  In conversations between cardiologists and patients with stable angina, informed decision making is often incomplete. More complete discussions are associated with patients choosing not to undergo angiography and possible PCI.
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Senthil K
authors.initials: SK
authors.lastname: Sivalingam
authors.affiliation: Division of General Medicine, Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Reva
authors.initials: R
authors.lastname: Kleppel
authors.affiliation: Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Marc
authors.initials: M
authors.lastname: Schweiger
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.affiliation: Health Decision Sciences, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Karen R
authors.initials: KR
authors.lastname: Sepucha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000601:surgery*; D017023:Coronary Angiography / Q000523:psychology*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000523:psychology*