Abstract 229: Patients’ Undergoing Cardiac Catheterization May Not Have Adequate Knowledge to Make Informed Decisions About Treatment

Objective: To be able to fully participate in a shared decision-making process, patients should be sufficiently knowledgeable about the risks and benefits of all available options, such that they can state informed preferences for care. Our objective was to assess knowledge about treatment options for coronary artery disease (CAD) and factors that are associated with a greater knowledge level about treatment. Methods: Cross-sectional survey of patients from four hospitals who were referred for cardiac catheterization for evaluation for CAD. The survey included 9 questions asking basic knowledge about the treatment options, 15 questions assessing decision-making processes (discussion of risks and benefits of treatment, preferred method of decision-making, and treatment preferences), demographics, and medical history. Knowledge was measured as the number of correct responses to the 9 questions about CAD treatment. Factors associated with a greater amount of knowledge were determined using multivariate linear regression. Results: One hundred forty-seven patients were surveyed around the time of cardiac catheterization with or without PCI. The sample had a mean age of 62 ±11 years, was 64% (94 of 147) male, 70% white (103 of 147), and 64% (94 of 147) had education beyond high school. Twenty-nine percent (43 of 147) of patients had prior myocardial infarction, 44% (64 of 147) had prior PCI, and 18% (26 of 147) had prior bypass surgery. The majority of patients (81%, 119 of 147) stated a preference for shared decision-making; however, when asked about their preferred treatment option, 46% (67 of 147) of patients indicated either that they were not sure what treatment they would choose or wanted their doctor to decide. The mean knowledge score was 5.0 ± 1.5 (range 1-8). In a multivariate linear regression model, white race (p=0.005), higher educational level (p<0.001), preference for shared decision-making (p=0.02), and a more robust discussion about treatment risks (p=0.047) were associated with a higher knowledge score. Age, sex, and prior cardiac history were not associated with knowledge level. Conclusions: Patients making decisions about CAD treatment may not have enough knowledge to make an informed decision, resulting in a substantial number of patients who were not sure which treatment they preferred. This may in part be due to incomplete discussions, particularly about treatment risks. Interventions to ensure more complete counseling, particularly for non-white and less educated patients, and encourage shared decision-making may improve patients’ ability to make informed decisions about treatment.