Abstract 86: What Do Patients Remember? The Knowledge Gap in Patients Undergoing Elective Percutaneous Coronary Interventions
Authors: Lin Grace , Bynum Julie , Cosenza Carol , Lucas Adam , Reinking Celeste , Sepucha Karen , Smolderen Kim , Dudley R. Adams 
Published: July 2021

Background:
There is increasing scrutiny of the use of elective percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD), due to the lack of mortality benefit compared with optimal medical therapy. Because of the clinical equipoise involved, decisions for elective PCI should include the preferences and involvement (to the extent desired) of a well-informed patient. However, there have been no large, national studies directly assessing knowledge and decision-making in patients with stable CAD undergoing elective procedures, so the overall state of knowledge in such patients is not clear. Our objective was to assess whether patients who have undergone elective PCI recalled critical facts and key decision-making processes regarding their treatment.

Methods:
National cross-sectional survey of 461 randomly sampled Medicare beneficiaries aged ≥ 65 who underwent elective PCI in 2008. Survey questions assessed patient demographics, cardiac history, decision-making processes, and knowledge. Knowledge was measured as the percentage of correct responses to 7 questions about the risks and benefits of elective PCI, bypass surgery and medical therapy for CAD. Questions about the decision-making process included assessment of physician-patient communication about the procedure and the patient's perception of their participation in the decision-making process. Association between knowledge and various predictors was determined using multivariate linear regression.

Results:
Patients answered a mean of 31.1% of questions correctly, and no patients answered all the questions correctly. Patients having undergone prior coronary artery bypass surgery had slightly more knowledge than those having their first PCI (mean correct score 36.7% vs. 29.4%, p<0.01). In a multivariate model, younger patients and patients who had previous bypass surgery were more knowledgeable. Neither educational level nor the patients’ subjective feeling of being informed was associated with knowledge level. Very few patients reported that their physicians talked about alternate treatment options (4.3%) or asked their preferences about the procedure (14.3%), two critical elements of shared decision-making; however, 67.3% of patients felt that decision-making was equally shared between the physician and patient.

Conclusions:
Medicare patients who underwent elective PCI had poor recollection about the benefits and risks of PCI, making it difficult to assess whether or not the patients made informed decisions. In addition, patients reported incomplete discussions about treatment alternatives and limited discussion of treatment preferences, despite reporting a high level of perceived shared decision-making. Although it is not clear whether the gaps in knowledge are a result of poor recall by the patient, poor knowledge transfer, or both, greater focus on improving patient knowledge and the physician-patient conversation about treatment alternatives and preferences is needed to ensure that elective PCIs are reflective of the preferences of well-informed patients.