Half of Heart Patients Unable to Recall Details of Informed Consent, Yet Most Satisfied
Duke University Medical Center researchers have found that while 50 percent of patients undergoing angioplasty or coronary artery bypass surgery could not recall specific risks or benefits of the procedure six weeks after the fact, over 90 percent were still satisfied with their knowledge of the procedures and communications with their physician.
Like other aspects of medicine, the key to patients' perception of being informed and satisfaction with their health care is the personal interaction between the patient and the physician, the researchers said.
"Ideally, the decisions for invasive cardiac care are made after the patient and doctor discuss the all risks and benefits of the procedure," said Duke cardiologist Karen Alexander, M.D., who presented the results of the Duke study today (April 1, 2003) during the 52nd annual scientific sessions of the American College of Cardiology.
"Informed consent and good clinical practice require a discussion of these risks and benefits, but there is very little data on the degree to which patients comprehend the specifics of this information," Alexander continued. "Our study showed that by only looking at patient recall, the basic tenets of informed consent are not met. This may be because many patients hear the information, but forget it rapidly in the stress of the acute setting. It is also shows that we need further studies to find out the most effective ways of explaining information to our patients so they retain it after they go home."
For the study, Alexander surveyed 679 patients who were admitted to Duke University Hospital complaining of chest pain, but before the decision for a cardiac catheterization was made. As a group, 65 percent went on to a cardiac catheterization, 18 percent had an angioplasty, and 8 percent underwent coronary artery bypass surgery.
Six weeks after hospital discharge, Alexander's team then contacted the patients who had procedures and asked them a series of questions regarding their recall of the procedure's risks and benefits and the discussion they had with their doctor.
The researchers found that, of the patients who received angioplasty 42 percent could not identify any risks, and 41 percent could not identify any benefits. For the surgery patients, 45 percent could not identify any risks and 22 percent could not identify any benefits. Furthermore, when asked to quantify the risks of the procedure, 78 percent of the angioplasty and 57 percent of the surgery patients could not.
"In general terms, those patients who knew the benefits of angioplasty and bypass surgery had higher satisfaction with their decision," Alexander said.
On the positive side, 94 percent were satisfied with their decision, 93 percent felt it was their decision to make, 89 percent felt adequately informed, and 82 percent felt they understood the risks and benefits, Alexander said.
"The personal interchange between doctor and patients is very important," she continued. "It could be after watching the doctor's face, listening closely to what the doctor said and how he or she said it, the patients felt comfortable that they understood the risk and benefits. The details of what was being explained weren?t as important as the trust that developed and the overall treatment recommendation."
As a group, the patients who received bypass surgery were better at recalling the benefits of their procedure when compared to the angioplasty group. The surgery patients knew that their procedure prolonged life (66 percent), relieved the symptoms of their heart disease (60 percent) and their procedure could prevent a heart attack (57 percent).
The study was supported by a grant from the Doris Duke Charitable Foundation, New York City. Joining Alexander in the study were Duke colleagues Tina Harding, Laura Coombs, Ph.D., and Eric Peterson, M.D.
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