26 Aug Patients Often Misinformed About Benefits of PCI for Heart Attack Prevention
MedicalResearch Interview with:
Michael B. Rothberg, MD, MPH
Department of Internal Medicine
Medicine Institute, Vice Chair for Research
Cleveland Clinic, Cleveland, Ohio
Medical Research: What are the main findings of the study?
Dr. Rothberg: In this randomized study we found that when people are presented with no information about the benefits of elective PCI, most assumed that it would prevent a heart attack. Unfortunately, this is incorrect, so people may choose to have the procedure based on false information. We also found that simply telling them that PCI would not prevent a heart attack successfully dispelled this belief for most, but not all, participants. Explaining why PCI does not prevent heart attacks in this circumstance was the most effective way to change people’s beliefs. We also found that most people were willing to take medications, but when they were told that PCI does not prevent heart attacks, they were more likely to agree to medication.
Medical Research: Were any of the findings unexpected?
Dr. Rothberg: We were surprised to find that even when the cardiologist explained why PCI would not prevent a heart attack, a substantial minority of patients did not believe the cardiologist. Others misremembered what the cardiologist had said and actually thought he said that PCI would prevent a heart attack. This was most common when the cardiologist said nothing.
Medical Research: What should clinicians and patients take away from your report?
Dr. Rothberg: Clinicians need to do a better job of presenting information to their patients. Our results suggest that it does not take a lot of time, but it is important to explicitly state that PCI will not prevent a heart attack and to explain why that is, as well as explaining why it is necessary to take medication regardless of whether or not the patient chooses to undergo PCI. Moreover, given how common and persistent the misconceptions were, it is important to verify that they patient has understood the information presented. One way to do this is using the “teach back” method, in which the patient is asked to teach the information back to the cardiologist and thereby demonstrate understanding.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Rothberg: We know that patients are misinformed about this subject and have been for the past 20 years or more. Our study suggests that if patients were given explicit information–even a few lines of text–it could change their opinions and their decisions. Future research is needed to see whether presenting this information in practice will affect patient decision making. Additional research is needed to know how best to present the information in order to maximize patient understanding.
Rothberg MB, Scherer L, Kashef M, et al. The Effect of Information Presentation on Beliefs About the Benefits of Elective Percutaneous Coronary Intervention. JAMA Intern Med. Published online August 25, 2014. doi:10.1001/jamainternmed.2014.3331.