Holmboe E S, Fiellin D A, Cusanelli E, Remetz M, Krumholz H M
Division of General Internal Medicine, Department of Medicine, National Naval Medical Center, Bethesda, MD 20889, USA.
J Gen Intern Med. 2000 Sep;15(9):632-7. doi: 10.1046/j.1525-1497.2000.90823.x.
To assess reasons why patients undergo elective percutaneous coronary revascularization (PCR), patient expectations of the benefits of PCR, and their understanding of the risks associated with PCR. We hypothesized that patients overestimate the benefits and underestimate the risks associated with PCR.
A prospective, semistructured questionnaire.
Patients undergoing their first elective PCR.
Fifty-two consecutive patients with a mean age of 64.3 years (range 39-87) completed the interview. Although 30 (57%) patients cited relief of symptoms as at least 1 reason to have PCR, 32 (62%) patients cited either an abnormal diagnostic test result (i.e., exercise stress test or catheterization) or "pathophysiologic" problem (i.e., "I have a blockage"), with 17 patients (33%) citing these reasons alone as indications for PCR. Thirty-nine (75%) patients believed PCR would prevent a future myocardial infarction, and 37 (71%) patients felt PCR would prolong their life. Regarding the potential complications, only 24 patients (46%) could recall at least 1 possible complication. However, on a Deber questionnaire, the majority of patients (67%) stated that they should determine either mostly alone or equally with a physician how acceptable the risks of the procedure are for themselves.
The majority of patients had unrealistic expectations about the long-term benefits of elective PCR and was not aware of the potential risks, even though they expressed a strong interest in participating in the decision to have PCR. More work is needed to define the optimal strategy to educate patients about the benefits and risks of elective PCR, and whether such education will affect patient decision making.
评估患者接受择期经皮冠状动脉血运重建术（PCR）的原因、对PCR益处的期望以及对与PCR相关风险的理解。我们假设患者高估了PCR的益处并低估了与之相关的风险。
一项前瞻性、半结构化问卷调查。
接受首次择期PCR的患者。
52例连续患者完成了访谈，平均年龄64.3岁（范围39 - 87岁）。尽管30例（57%）患者将症状缓解列为至少一个进行PCR的原因，但32例（62%）患者提到了异常的诊断检查结果（即运动负荷试验或心导管检查）或“病理生理”问题（即“我有堵塞”），其中17例（33%）患者仅将这些原因作为进行PCR的指征。39例（75%）患者认为PCR可预防未来心肌梗死，37例（71%）患者觉得PCR可延长寿命。关于潜在并发症，只有24例（46%）患者能回忆起至少一种可能的并发症。然而，在一份德伯问卷中，大多数患者（67%）表示他们应主要独自或与医生平等地确定该手术风险对自己来说的可接受程度。
大多数患者对择期PCR的长期益处抱有不切实际的期望，且未意识到潜在风险，尽管他们表示对参与是否进行PCR的决策有浓厚兴趣。需要开展更多工作来确定对患者进行择期PCR益处和风险教育的最佳策略，以及这种教育是否会影响患者的决策。
