PCI Choice Decision Aid for Stable Coronary Artery Disease: A Randomized Trial.
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.



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.



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.



URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01771536.
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.). megan.coylewright@dartmouth.edu.
Megan
M
Coylewright
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Sara
S
Dick
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Becky
B
Zmolek
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Jason
J
Askelin
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Edward
E
Hawkins
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Megan
M
Branda
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Jonathan W
JW
Inselman
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Claudia
C
Zeballos-Palacios
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Nilay D
ND
Shah
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Erik P
EP
Hess
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Annie
A
LeBlanc
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Victor M
VM
Montori
From the Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.C.); Knowledge and Evaluation Research Unit (S.D., M.B., J.W.I., C.Z.-P., N.D.S., E.P.H., A.L., V.M.M.), Department of Nursing, Earl H. Wood Cardiac Catheterization Laboratory (B.Z., J.A., E.H.), Division of Health Care Policy and Research, Department of Health Sciences Research (N.D.S., A.L.), Division of Emergency Medicine Research, Department of Emergency Medicine (E.P.H.), and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (V.M.M.), Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN (M.B., J.W.I.); and New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY (H.H.T.).
Henry H
HH
Ting
D000368:Aged; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002755:Choice Behavior; D000066491:Clinical Decision-Making; D003220:Conflict, Psychological; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000209:etiology; D010353:Patient Education as Topic; D010358:Patient Participation; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents
coronary artery disease; decision making, shared; decision support techniques; patient-centered care; percutaneous coronary intervention