Developing and Testing a Personalized, Evidence-Based, Shared Decision-Making Tool for Stent Selection in Percutaneous Coronary Intervention Using a Pre-Post Study Design.

Creator(s)

Adnan K. Chhatriwalla
Carole Decker
Elizabeth Gialde
Delwyn Catley, Children's Mercy HospitalFollow
Kathy Goggin, Children's Mercy HospitalFollow
Katie Jaschke
Philip Jones
Dave deBronkart
Tony Sun
John A. Spertus

Document Type

Article

Publication Date

2-2019

Identifier

DOI: 10.1161/CIRCOUTCOMES.118.005139; PMCID: PMC6383794

Abstract

Background Drug-eluting stents reduce the risk of restenosis in patients undergoing percutaneous coronary intervention, but their use necessitates prolonged dual antiplatelet therapy, which increases costs and bleeding risk, and which may delay elective surgeries. While >80% of patients in the United States receive drug-eluting stents, less than a third report that their physicians discussed options with them. Methods and Results An individualized shared decision-making (SDM) tool for stent selection was designed and implemented at 2 US hospitals. In the postimplementation phase, all patients received the SDM tool before their procedure, with or without decision coaching from a trained nurse. All patients were interviewed with respect to their knowledge of stents, their participation in SDM, and their stent preference. Between May 2014 and December 2016, 332 patients not receiving the SDM tool, 113 receiving the SDM tool with coaching, and 136 receiving the tool without coaching were interviewed. Patients receiving the SDM tool + coaching, as compared with usual care, demonstrated higher knowledge scores (mean difference +1.8; PNCT02046902.

Journal Title

Circ Cardiovasc Qual Outcomes

Volume

12

Issue

2

First Page

005139

Last Page

005139

MeSH Keywords

Aged; Clinical Decision-Making; Counseling; Decision Making, Shared; Decision Support Techniques; Drug-Eluting Stents; Evidence-Based Medicine; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Missouri; Patient Education as Topic; Patient Participation; Patient Preference; Patient Selection; Percutaneous Coronary Intervention; Prosthesis Design

Keywords

coronary artery disease; drug-eluting stent; percutaneous coronary intervention; stents

Comments

Grant support

• CE-1304-6448/PCORI/Patient-Centered Outcomes Research Institute/United States

Recommended Citation

Chhatriwalla AK, Decker C, Gialde E, et al. Developing and Testing a Personalized, Evidence-Based, Shared Decision-Making Tool for Stent Selection in Percutaneous Coronary Intervention Using a Pre-Post Study Design. Circ Cardiovasc Qual Outcomes. 2019;12(2):e005139. doi:10.1161/CIRCOUTCOMES.118.005139