Kureshi Faraz, Jones Philip G, Buchanan Donna M, Abdallah Mouin S, Spertus John A
Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA University of Missouri- Kansas City, Kansas City, MO, USA
Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA.
BMJ. 2014 Sep 8;349:g5309. doi: 10.1136/bmj.g5309.
To assess the perceptions of patients with stable coronary artery disease of the urgency and benefits of elective percutaneous coronary intervention and to examine how they vary across centers and by providers.
Cross sectional study.
10 US academic and community hospitals performing percutaneous coronary interventions between 2009 and 2011.
991 patients with stable coronary artery disease undergoing elective percutaneous coronary intervention.
Patients' perceptions of the urgency and benefits of percutaneous coronary intervention, assessed by interview. Multilevel hierarchical logistic regression models examined the variation in patients' understanding across centers and operators after adjusting for patient characteristics, using median odds ratios.
The most common reported benefits from percutaneous coronary intervention were to extend life (90%, n=892; site range 80-97%) and to prevent future heart attacks (88%, n=872; site range 79-97%). Although nearly two thirds of patients (n=661) reported improvement of symptoms as a benefit of percutaneous coronary intervention (site range 52-87%), only 1% (n=9) identified this as the only benefit. Substantial variability was noted in the ways informed consent was obtained at each site. After adjusting for patient and operator characteristics, the median odds ratios showed significant variation in patients' perceptions of percutaneous coronary intervention across sites (range 1.4-3.1) but not across operators within a site.
Patients have a poor understanding of the benefits of elective percutaneous coronary intervention, with significant variation across sites. No sites had a high proportion of patients accurately understanding the benefits. Coupled with the wide variability in the ways in which hospitals obtain informed consent, these findings suggest that hospital level interventions into the structure and processes of obtaining informed consent for percutaneous coronary intervention might improve patient comprehension and understanding.
评估稳定型冠状动脉疾病患者对择期经皮冠状动脉介入治疗紧迫性和益处的看法，并研究这些看法在不同中心和不同医疗服务提供者之间的差异。
横断面研究。
2009年至2011年间在美国进行经皮冠状动脉介入治疗的10家学术和社区医院。
991例接受择期经皮冠状动脉介入治疗的稳定型冠状动脉疾病患者。
通过访谈评估患者对经皮冠状动脉介入治疗紧迫性和益处的看法。多水平分层逻辑回归模型在调整患者特征后，使用中位数优势比研究了不同中心和手术医生之间患者理解的差异。
经皮冠状动脉介入治疗最常报告的益处是延长生命（90%，n = 892；各中心范围为80 - 97%）和预防未来心脏病发作（88%，n = 872；各中心范围为79 - 97%）。尽管近三分之二的患者（n = 661）报告症状改善是经皮冠状动脉介入治疗的益处（各中心范围为52 - 87%），但只有1%（n = 9）的患者认为这是唯一益处。各中心在获取知情同意的方式上存在很大差异。在调整患者和手术医生特征后，中位数优势比显示不同中心患者对经皮冠状动脉介入治疗的看法存在显著差异（范围为1.4 - 3.1），但同一中心内不同手术医生之间无显著差异。
患者对择期经皮冠状动脉介入治疗益处的理解较差，各中心之间存在显著差异。没有一个中心有高比例的患者准确理解其益处。再加上医院在获取知情同意方式上的广泛差异，这些发现表明，针对经皮冠状动脉介入治疗获取知情同意的结构和流程进行医院层面的干预可能会提高患者的理解。
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