A randomized controlled trial of information‐giving to patients referred for coronary angiography: effects on outcomes of care

Abstract

Objective To assess the impact of providing an educational videotape,`Treatment Choices for Ischaemic Heart Disease: a Shared Decision-Making Program Videotape,' to patients referred for coronary angiography compared with standard patient-physician decision making (usual care). Study design Randomized controlled clinical trial.Setting University Hospital and Veterans A airs Hospital.Patients A consecutive sample of 217 patients referred for coronary angiography were randomized to receive`usual care' or to receive the videotape in addition to standard patient physician decision making (videotape): 109 completed the study (50% completion rate).Main outcome measures Knowledge of coronary artery disease, satisfaction, self-reported physical and mental health functioning, and the proportion of patients who were referred for coronary revascularization.Results Compared with patients who received`usual care,' those who received the videotape were more knowledgeable (mean score 83 vs. 58%; P < 0.0001) but less satis®ed with their treatment (79 vs. 88%; P 0.038). There were no signi®cant differences between the videotape and`usual care' groups with respect to satisfaction with the decision making process (mean score 73 vs. 77%; P 0.37), satisfaction with the decision made (mean score 73 vs. 78%; P 0.28), physical functioning (38 vs. 38%; P 0.76), mental health functioning (49 vs. 49%; P 0.94), or in referral for coronary revascularization (OR 0.60; 95% CI 0.22±1.65; P 0.33).Conclusion Although the educational videotape increased patients' knowledge level, it was associated with a decrease in their level of satisfaction with treatment. Before there is wide-spread dissemination of this technology, advocates should demonstrate its e ectiveness in everyday practice.

Impact of a patient decision aid on care among patients with nonvalvular atrial fibrillation: a cluster randomized trial

“…For example, all 9 trials evaluating knowledge have shown that decision aids significantly improve patient knowledge, with a weighted mean difference of 19% (compared with 16% in this trial). 8,[12][13][14][15][16][17][18][19][20] Similarly, all 6 of the trials that examined decisional conflict reported statistically significant improvements with decision aids of magnitudes virtually identical to our results. 17,18,[21][22][23][24] However, decision aids have had variable impacts on management in the 3 tri- als evaluating medical therapies: one 24 reported a 76% increase in hepatitis B vaccination with a decision aid, another 25 reported a nonsignificant 8% reduction in hormone replacement use, and the third 17 reported a nonsignificant 6% increase in ASA use among patients with NVAF at low risk of stroke.…”

Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease

“…In two other reported randomized trials of SDPs, patients' satisfaction with the decision-making process was also found to be reasonably high. 19,21 In the first study, men with BPH were found to have a mean score for patients' satisfaction with the decision-making process of 76% when exposed to the interactive videodisc, compared with 71% for the control group at 3 months ( P ϭ .03). 19 The clinical significance of this 5% improvement is uncertain and is within the 95% confidence interval of our results.…”

“…The mean score for satisfaction with the decision-making process was 75% in both groups. 21 Evidence that the IHD SDP assists in the decisionmaking process is provided by the increase in knowledge. In this study, SDP patients scored significantly higher than controls on the multi-item knowledge scale, with mean scores of 75% and 62%, respectively (Table 2).…”

“…This observation is consistent with other reported results. [19][20][21] The IHD SDP was successful as a decision aid in assisting patients in acquiring knowledge deemed important in the decision-making process. This observation offers support for the use of decision aids to improve the informed consent process.…”

“…20 A recently published randomized, controlled trial of a videotape version of the IHD SDP revealed that those who viewed the videotape were more knowledgeable but less satisfied with their treatment decision. 21 The IHD SDP represents the "state of the art" for informed decision making. 22 Ideally, if shared decision-making programs are to be widely accepted as an essential component of health care delivery, they must be shown to assist patients in informed and effective decision making, decrease unjustified practice variation, and result in higher quality health care.…”