Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012;7(11):e49827.
doi: 10.1371/journal.pone.0049827. Epub 2012 Nov 30.

Shared decision making in patients with stable coronary artery disease: PCI choice

Megan Coylewright  1 , Kathy Shepel, Annie Leblanc, Laurie Pencille, Erik Hess, Nilay Shah, Victor M Montori, Henry H Ting
Affiliations

Shared decision making in patients with stable coronary artery disease: PCI choice

Megan Coylewright et al. PLoS One. 2012.

Abstract

Background: Percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) are comparable, alternative therapies for many patients with stable angina; however, patients may have misconceptions regarding the impact of PCI on risk of death and myocardial infarction (MI) in stable coronary artery disease (CAD).

Methods and results: We designed and developed a patient-centered decision aid (PCI Choice) to promote shared decision making for patients with stable CAD. The estimated benefits and risks of PCI+OMT as compared to OMT were displayed in a decision aid using pictographs with natural frequencies and text. We engaged patients, clinicians, health service researchers, and designers with over 20 successive iterations of the decision aid, which were field tested during real-world clinical encounters involving clinicians and patients. The decision aid is intended to facilitate knowledge transfer, deliberation based on patient values and preferences, and shared decision making.

Conclusions: We describe the methods and outcomes of the design and development of a decision aid (PCI Choice) to promote shared decision making between clinicians and patients regarding the choice of PCI+OMT vs. OMT for treatment of stable CAD. We will evaluate the impact of PCI Choice on patient knowledge, decisional conflict, participation in decision-making, and treatment choice in an upcoming randomized trial.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Process for development and prototyping of decision aid.
Figure 2
Figure 2. Flow of care for patients with chronic stable angina; red border indicates potential for shared decision making.
Figure 3
Figure 3. PCI Choice: early prototype of benefits page.
Used with permission of Mayo Foundation for Medical Education and Research; Creative Commons License does not apply.
Figure 4
Figure 4. PCI Choice: final prototype.
Used with permission of Mayo Foundation for Medical Education and Research; Creative Commons License does not apply.
See this image and copyright information in PMC

References

    1. Stergiopoulos K, Brown DL (2012) Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: Meta-analysis of randomized controlled trials. Arch Intern Med 172: 312–319. - PubMed
    1. Brooks MM, Chung S-C, Helmy T, Hillegass WB, Escobedo J, et al. (2010) Health status after treatment for coronary artery disease and type 2 diabetes mellitus in the Bypass Angioplasty Revascularization Investigation 2 Diabetes Trial/Clinical perspective. Circulation 122: 1690–1699. - PMC - PubMed
    1. Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, et al. (2008) Effect of PCI on quality of life in patients with stable coronary disease. The New England Journal of Medicine 359: 677–687. - PubMed
    1. Rothberg MB, Sivalingam SK, Ashraf J, Visintainer P, Joelson J, et al. (2010) Patients' and cardiologists' perceptions of the benefits of percutaneous coronary intervention for stable coronary disease. Annals of Internal Medicine 153: 307–313. - PubMed
    1. O'Connor AM, Llewellyn-Thomas HA, Flood AB (2004) Modifying unwarranted variations in health care: Shared decision making using patient decision aids. Health Affairs - PubMed

Publication types

MeSH terms

Substances