Assuntos
Cardiologia/normas , Doenças Cardiovasculares/terapia , Prestação Integrada de Cuidados de Saúde/normas , Medicina Baseada em Evidências/normas , Avaliação de Processos em Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Sistema de Registros/normas , Cardiologia/ética , Doenças Cardiovasculares/diagnóstico , Conflito de Interesses , Prestação Integrada de Cuidados de Saúde/ética , Medicina Baseada em Evidências/ética , Setor de Assistência à Saúde/ética , Setor de Assistência à Saúde/normas , Humanos , Relações Interinstitucionais , Avaliação de Processos em Cuidados de Saúde/ética , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde/ética , Sistema de Registros/ética , Resultado do TratamentoRESUMO
BACKGROUND: Percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) are comparable, alternative therapies for many patients with stable angina; however, patients may have misconceptions regarding the impact of PCI on risk of death and myocardial infarction (MI) in stable coronary artery disease (CAD). METHODS AND RESULTS: We designed and developed a patient-centered decision aid (PCI Choice) to promote shared decision making for patients with stable CAD. The estimated benefits and risks of PCI+OMT as compared to OMT were displayed in a decision aid using pictographs with natural frequencies and text. We engaged patients, clinicians, health service researchers, and designers with over 20 successive iterations of the decision aid, which were field tested during real-world clinical encounters involving clinicians and patients. The decision aid is intended to facilitate knowledge transfer, deliberation based on patient values and preferences, and shared decision making. CONCLUSIONS: We describe the methods and outcomes of the design and development of a decision aid (PCI Choice) to promote shared decision making between clinicians and patients regarding the choice of PCI+OMT vs. OMT for treatment of stable CAD. We will evaluate the impact of PCI Choice on patient knowledge, decisional conflict, participation in decision-making, and treatment choice in an upcoming randomized trial.