Informed consent programs are somewhat beneficial for improving patient comprehension prior to cardiac revascularization, but many patients still have misconceptions about benefits and outcomes, according to a study in the May 2014 issue of The Annals of Thoracic Surgery.
Shubha Dathatri, PhD and Todd K. Rosengart, MD, from the Baylor College of Medicine in Houston, TX, and colleagues studied the effectiveness of two pre-procedural educational approaches to enhance patients’ knowledge about cardiac revascularization procedures, including percutaneous coronary intervention (PCI; involves the insertion of metal stents into narrowed or blocked coronary arteries).
The researchers randomly assigned 102 patients undergoing first-time elective cardiac catheterization and possible PCI to a scripted verbal/written consent process (Group 1) or a web-based, audiovisual presentation (Group 2). Previous studies have suggested that using interactive or audiovisual materials is more effective than standard verbal or written consent.
“The primary finding of our study was that, contrary to expectations, even with the use of verbal scripted and multimedia consent mechanisms, patient understanding of the risks, benefits, and alternatives with regard to the procedures being discussed during informed consent remained deficient,” said Dr. Dathatri. Notably, the researchers found that patients had inflated expectations about benefits of cardiac revascularization after the consent process.
Prior to the process, overall procedural comprehension level was poor, with only 25% of participants correctly identifying all risks, 0% identifying all the benefits, and 23% identifying alternatives.
Although all patients showed improved overall comprehension following the educational program, and patients in group 2 showed significantly greater improvement in identification of treatment alternatives compared with patients in group 1, misperceptions about benefits persisted among patients in both groups.
“Patients overestimated the benefits of PCI, believing the procedure will ‘cure’ them of heart disease,” said Dr. Rosengart. “This misperception is dangerous because patients will need to take heart disease seriously.”
He added that the informed consent process could be improved through an even greater use of interactive tools, as well as incorporation of a “heart team,” where cardiologists and surgeons provide different perspectives on the contemplated procedures.
“We also need to include process check points where the clinician assesses the extent to which the patient understands what is being communicated, clarifies potential misunderstanding, and reviews pertinent information again. These extra steps will help enhance patient education and the informed consent process,” said Dr. Rosengart.
- Shubha Dathatri, Luis Gruberg, Jatin Anand, Jamie Romeiser, Shephali Sharma, Eileen Finnin, A. Laurie W. Shroyer, Todd K. Rosengart. Informed Consent for Cardiac Procedures: Deficiencies in Patient Comprehension With Current Methods. The Annals of Thoracic Surgery, 2014; 97 (5): 1505 DOI: 10.1016/j.athoracsur.2013.12.065
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