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Original Investigation
October 2014

How Cardiologists Present the Benefits of Percutaneous Coronary Interventions to Patients With Stable Angina: A Qualitative Analysis

Author Affiliations
  • 1Department of Internal Medicine, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts
  • 2The Center for Quality of Care Research, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts
  • 3Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester
  • 4Division of Cardiovascular Diseases, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
  • 5Department of Internal Medicine, Cleveland Clinic Medicine Institute, Cleveland, Ohio
JAMA Intern Med. 2014;174(10):1614-1621. doi:10.1001/jamainternmed.2014.3328

Importance  Patients with stable coronary artery disease (CAD) attribute greater benefit to percutaneous coronary interventions (PCI) than indicated in clinical trials. Little is known about how cardiologists’ presentation of the benefits and risks may influence patients’ perceptions.

Objectives  To broadly describe the content of discussions between patients and cardiologists regarding angiogram and PCI for stable CAD, and to describe elements that may affect patients’ understanding.

Design, Setting, and Participants  Qualitative content analysis of encounters between cardiologists and patients with stable CAD who participated in the Verilogue Point-of-Practice Database between March 1, 2008, and August 31, 2012. Transcripts in which angiogram and PCI were discussed were retrieved from the database. Patients were aged 44 to 88 years (median, 64 years); 25% were women; 50% reported symptoms of angina; and 6% were taking more than 1 medication to treat angina.

Main Outcomes and Measures  Results of conventional and directed qualitative content analysis.

Results  Forty encounters were analyzed. Five major categories and subcategories of factors that may affect patients’ understanding of benefit were identified: (1) rationale for recommending angiogram and PCI (eg, stress test results, symptoms, and cardiologist’s preferences); (2) discussion of benefits (eg, accurate discussion of benefit [5%], explicitly overstated benefit [13%], and implicitly overstated benefit [35%]); (3) discussion of risks (eg, minimization of risk); (4) cardiologist’s communication style (eg, humor, teach-back, message framing, and failure to respond to patient questions); and (5) patient and family member contributions to the discussion.

Conclusions and Relevance  Few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. The etiology of patient misunderstanding is likely multifactorial, but if future quantitative studies support the findings of this hypothesis-generating analysis, modifications to cardiologists’ approach to describing the risks and benefits of the procedure may improve patient understanding.