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 Researchers analyzed recordings of 59 conversations between
cardiologists and patients about a common procedure called
percutaneous coronary intervention (PCI), which is done to reopen
arteries and restore blood flow to the heart - and found just two
discussions covered all the points needed for patients to make an
informed decision.
“When you are facing a decision that has a number of consequences
one way or the other, there are a number of issues that you are
supposed to address and we found, overall, that very few
conversations had all the elements,” said Dr. Michael Rothberg, of
the Center for Value Based Care Research at Cleveland Clinic in
Ohio.
The procedure, also referred to as a balloon angioplasty, involves
attaching a tiny deflated balloon to special tubing that’s threaded
through arteries to the site of the blockage. Then, surgeons inflate
the balloon to clear away the debris, often leaving a tiny wire mesh
cage called a stent inside the vessel to prevent future clogging.
While the procedure can relieve pain and prevent heart attacks in
some patients, it doesn’t benefit everybody and it also carries
risks such as infections, damage to blood vessels or a ruptured
artery that requires open-heart surgery to repair.
“Having a PCI if you don’t really need one is not something an
informed patient would do,” said Floyd Fowler, Jr., a senior
scientific advisor at the Informed Medical Decisions Foundation who
wasn’t involved in the study. Without enough information about the
advantages and harms of a procedure as well as any alternative
treatments, patients may overestimate the benefits of surgery, he
said by email.
The study focused on patients considering the procedure to relieve
symptoms of chronic stable angina, a type of chest pain that can
flare up as a result of exercise or stress and can sometimes be
managed with rest or medication.
Doctors discussed alternative treatments just 25 percent of the
time, and were even less likely to take time to confirm whether
patients understood information or to explain the pros and cons of
different stents that might be used during surgery.
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In most conversations, physicians recommended the procedure and when
they did, most patients followed their advice. In the rare instances
when doctors didn’t express an opinion or recommended against the
procedure, patients always listened.
Most patients with chronic stable angina falsely believe that this
operation can prevent heart attacks or death, even though its main
benefit is easing chest pain, the researchers note in JAMA Internal
Medicine.
“Patients should be asking if the treatment will affect how long
they live or prevent an event like a heart attack,” Dr. Grace Lin,
an internist at the University of San Francisco Medical Center and
co-author of an editorial published with the study, said by email.
“Patients should consider asking for a second opinion if they feel
like they haven’t been given all the information they need in order
to feel comfortable making a decision.”
SOURCE: http://bit.ly/1EYtdwf JAMA Internal Medicine, online May 18,
2015.
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