Improving the Quality of Informed Consent: It Is Not All About the Risks
Authors: Alicia Fernandez
Journal: Annals of Internal Medicine (2010)

Editorials7 September 2010Improving the Quality of Informed Consent: It Is Not All About the RisksAlicia Fernandez, MDAlicia Fernandez, MDFrom University of California, San Francisco, San Francisco, CA 94143-1364.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-5-201009070-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Percutaneous coronary intervention (PCI) for stable coronary artery disease is one of the most common invasive procedures performed in the United States (1). Since the publication of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial in 2007 (2), PCI is widely recognized to offer more immediate relief of angina than optimal medical therapy in stable patients with coronary artery disease, while conferring no additional benefit in the risk for myocardial infarction (MI) or death.Try telling that to patients. In this issue, Rothberg and colleagues' provocative survey (3) of 153 patients who consented to elective angiography with ...References1. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, DeSimone G, et al; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010;121:46-e215. [PMID: 20019324] MedlineGoogle Scholar2. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-16. [PMID: 17387127] CrossrefMedlineGoogle Scholar3. Rothberg MB, Sivalingam SK, Ashraf J, Visintainer P, Joelson J, Kleppel R, et al. Patients' and cardiologists' perceptions of the benefits of percutaneous coronary intervention for stable coronary disease. Ann Intern Med. 2010;153:307-13. [PMID: 17387127] LinkGoogle Scholar4. Lin GA, Dudley RA, Redberg RF. Cardiologists' use of percutaneous coronary interventions for stable coronary artery disease. Arch Intern Med. 2007;167:1604-9. [PMID: 17698682] CrossrefMedlineGoogle Scholar5. Lin GA, Dudley RA, Redberg RF. Why physicians favor use of percutaneous coronary intervention to medical therapy: a focus group study. J Gen Intern Med. 2008;23:1458-63. [PMID: 18618192] CrossrefMedlineGoogle Scholar6. Sudore RL, Landefeld CS, Williams BA, Barnes DE, Lindquist K, Schillinger D. Use of a modified informed consent process among vulnerable patients: a descriptive study. J Gen Intern Med. 2006;21:867-73. [PMID: 16881949] CrossrefMedlineGoogle Scholar7. Schenker Y, Wang F, Selig SJ, Ng R, Fernandez A. The impact of language barriers on documentation of informed consent at a hospital with on-site interpreter services. J Gen Intern Med. 2007;22 Suppl 2 294-9. [PMID: 17957414] CrossrefMedlineGoogle Scholar8. Wash. Rev. Code §7.70.060 (2005). Accessed at apps.leg.wa.gov/rcw/default.aspx?cite=7.70.060 on 29 July 2010. Google Scholar9. Schenker Y, Fernandez A, Sudore R, Schillinger D. Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review. Med Decis Making. 2010;:. [PMID: 20357225] MedlineGoogle Scholar10. Volk RJ, Hawley ST, Kneuper S, Holden EW, Stroud LA, Cooper CP, et al. Trials of decision aids for prostate cancer screening: a systematic review. Am J Prev Med. 2007;33:428-434. [PMID: 17950409] CrossrefMedlineGoogle Scholar11. Whelan T, Levine M, Willan A, Gafni A, Sanders K, Mirsky D, et al. Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. JAMA. 2004;292:435-41. [PMID: 15280341] CrossrefMedlineGoogle Scholar12. O'Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2009;:CD001431. [PMID: 19588325] MedlineGoogle Scholar13. Woolf SH, Chan EC, Harris R, Sheridan SL, Braddock CH, Kaplan RM, et al. Promoting informed choice: transforming health care to dispense knowledge for decision making. Ann Intern Med. 2005;143:293-300. [PMID: 16103473] LinkGoogle Scholar14. Wills CE, Holmes-Rovner M. Patient comprehension of information for shared treatment decision making: state of the art and future directions. Patient Educ Couns. 2003;50:285-90. [PMID: 12900101] CrossrefMedlineGoogle Scholar15. Foundation for Informed Medical Decision Making. Patient decision aids. Accessed at www.informedmedicaldecisions.org/patient_decision_aids.html on 29 July 2010. Google Scholar16. Braddock CH, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282:2313-20. [PMID: 10612318] CrossrefMedlineGoogle Scholar17. Lucas FL, Siewers AE, Malenka DJ, Wennberg DE. Diagnostic-therapeutic cascade revisited: coronary angiography, coronary artery bypass graft surgery, and percutaneous coronary intervention in the modern era. Circulation. 2008;118:2797-802. [PMID: 19064681] CrossrefMedlineGoogle Scholar18. Belkora J, Edlow B, Aviv C, Sepucha K, Esserman L. Training community resource center and clinic personnel to prompt patients in listing questions for doctors: follow-up interviews about barriers and facilitators to the implementation of consultation planning. Implement Sci. 2008;3:6. [PMID: 18237380] CrossrefMedlineGoogle Scholar19. O'Connor AM, Wennberg JE, Legare F, Llewellyn-Thomas HA, Moulton BW, Sepucha KR, et al. Toward the ‘tipping point’: decision aids and informed patient choice. Health Aff (Millwood). 2007;26:716-25. [PMID: 17485749] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, San Francisco, San Francisco, CA 94143-1364.Acknowledgment: The author acknowledges Rachel Stern, BA, for insightful comments on earlier versions of this editorial.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1687.Corresponding Author: Alicia Fernandez, MD, Department of Medicine, University of California, San Francisco, Box 1364, San Francisco, CA 94143-1364; e-mail, [email protected]ucsf.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPatients' and Cardiologists' Perceptions of the Benefits of Percutaneous Coronary Intervention for Stable Coronary Disease Michael B. Rothberg , Senthil K. Sivalingam , Javed Ashraf , Paul Visintainer , John Joelson , Reva Kleppel , Neelima Vallurupalli , and Marc J. Schweiger Patients' and Cardiologists' Perceptions of the Benefits of Percutaneous Coronary Intervention for Stable Coronary Disease Yael Schenker and Alan Meisel Metrics Cited ByThe Association Between Limited English Proficiency and Unplanned Emergency Department Revisit Within 72 HoursEthics in Pediatric OncologyProfessional Liability Claims in Vascular Surgery PracticeClinical evidence versus patients’ perception of coronary revascularizationCase 34-2010: A Woman with an Incorrect OperationPatients' and Cardiologists' Perceptions of the Benefits of Percutaneous Coronary Intervention for Stable Coronary DiseaseYael Schenker, MD, MAS and Alan Meisel, JD 7 September 2010Volume 153, Issue 5Page: 342-343KeywordsAnginaAngiographyBreast cancerCancer treatmentConflicts of interestDecision makingPercutaneous coronary interventionStable coronary artery diseaseSurgerySystematic reviews ePublished: 7 September 2010 Issue Published: 7 September 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...