Preface by e-Patient Dave: We have often written here (see posts) about Shared Decision Making, in which patients are engaged in choosing among treatment options. A key method is to give patients a “decision aid” (DA) – a document or video that explains the options, with pro’s and cons.
A vital question in the design of a DA is, which factors should patients be informed about? And who decides that? In this case a researcher is asking for patient opinions (!) on what should be included in a DA for stents. (See the National Institutes of Health introduction to stents.) SPM member Marilyn Mann (@MarilynMann) knows a lot about stents – this is her first post here.
Adnan Chhatriwalla, MD, is a cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City, and is co-investigator for DECIDE-PCI, a study designed to develop and test a decision aid (DA) for patients who have decided to have one or more stents inserted in their coronary arteries. (Note: this is not about whether to have a stent at all — that would be a separate decision.)
One of the drawbacks associated with stents is that over time, scar tissue can grow into the artery and make it narrow again. This can make it necessary to do another stenting procedure to open up the artery. “Drug-eluting” stents are coated with drugs that reduce the risk of the scar tissue forming and narrowing the artery. However, drug-eluting stents have the drawback that they require the patient to take blood thinners for a much longer period of time, as compared to bare metal stents. This adds costs and increases the risk of bleeding.
The study is in the beginning phase, and the researchers are engaging patients in focus groups to better understand what factors are most important to them in choosing a stent. The focus groups will also involve asking patients how they prefer the information to be presented (e.g., in words, graphs, some combination of the two, and so forth). Later, the decision aid will be tested at two hospitals to see if it improves patient understanding and satisfaction, and if the use of the decision aid changes the percentages of bare metal stents and drug-eluting stents received by the patients.
Dr. Chhatriwalla is very interested in getting feedback from patients and others on the current drafts of the decision aid (two different versions) and has asked SPM to help circulate them. You do not need to be a heart disease patient to participate — the researchers are interested in a wide range of viewpoints. Please take a look at both of them (posted below) and send your comments to Dr. Chhatriwalla at firstname.lastname@example.org.