Yuan Neal, Boscardin Christy, Lisha Nadra E, Dudley R Adams, Lin Grace A
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
Patient Prefer Adherence. 2021 Jan 26;15:119-126. doi: 10.2147/PPA.S289398. eCollection 2021.
In stable coronary artery disease (CAD), shared decision-making (SDM) is encouraged when deciding whether to pursue percutaneous coronary intervention (PCI) given similar cardiovascular outcomes between PCI and medical therapy. However, it remains unclear whether improving patient-provider communication and patient knowledge, the main tenets of SDM, changes patient preferences or the treatment chosen. We explored the relationships between patient-provider communication, patient knowledge, patient preferences, and the treatment received.
We surveyed stable CAD patients referred for elective cardiac catheterization at seven hospitals from 6/2016 to 9/2018. Surveys assessed patient-provider communication, medical knowledge, and preferences for treatment and decision-making. We verified treatments received by chart review. We used linear and logistic regression to examine relationships between patient-provider communication and knowledge, knowledge and preference, and preference and treatment received.
Eighty-seven patients completed the survey. More discussion of the benefits and risks of both medical therapy and PCI associated with higher patient knowledge scores (β=0.28, p<0.01). Patient knowledge level was not associated with preference for PCI (OR=0.78, 95% CI 0.57-1.03, p=0.09). Black patients had more than four times the odds of preferring medical therapy to PCI (OR=4.49, 1.22-18.45, p=0.03). Patients preferring medical therapy were not significantly less likely to receive PCI (OR=0.67, 0.16-2.52, p=0.57).
While communicating the risks of PCI may improve patient knowledge, this knowledge may not affect patient treatment preferences. Rather, other factors such as race may be significantly more influential on a patient's treatment preferences. Furthermore, patient preferences are still not well reflected in the treatment received. Improving shared decision-making in stable CAD therefore may require not only increasing patient education but also better understanding and including a patient's background and pre-existing beliefs.
在稳定型冠状动脉疾病（CAD）中，鉴于经皮冠状动脉介入治疗（PCI）和药物治疗具有相似的心血管结局，在决定是否进行PCI时鼓励采用共同决策（SDM）。然而，改善医患沟通和患者知识水平（SDM的主要原则）是否会改变患者的偏好或所选治疗方案仍不清楚。我们探讨了医患沟通、患者知识、患者偏好与所接受治疗之间的关系。
我们对2016年6月至2018年9月期间在七家医院接受择期心导管检查的稳定型CAD患者进行了调查。调查评估了医患沟通、医学知识以及治疗和决策偏好。我们通过病历审查核实了所接受的治疗。我们使用线性回归和逻辑回归来检验医患沟通与知识、知识与偏好、偏好与所接受治疗之间的关系。
87名患者完成了调查。对药物治疗和PCI的益处及风险进行更多讨论与更高的患者知识得分相关（β=0.28，p<0.01）。患者知识水平与PCI偏好无关（OR=0.78，95%CI 0.57-1.03，p=0.09）。黑人患者选择药物治疗而非PCI的几率是其他人的四倍多（OR=4.49，1.22-18.45，p=0.03）。选择药物治疗的患者接受PCI的可能性并未显著降低（OR=0.67，0.16-2.52，p=0.57）。
虽然告知PCI风险可能会提高患者知识水平，但这种知识可能不会影响患者的治疗偏好。相反，种族等其他因素可能对患者的治疗偏好有显著更大的影响。此外，患者偏好仍未在所接受的治疗中得到很好体现。因此，改善稳定型CAD中的共同决策可能不仅需要加强患者教育，还需要更好地理解并纳入患者的背景和既有信念。
