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Original Investigation |

The Effect of Information Presentation on Beliefs About the Benefits of Elective Percutaneous Coronary Intervention

Michael B. Rothberg, MD, MPH1; Laura Scherer, PhD2; Mohammad Amin Kashef, MD3; Megan Coylewright, MD, MPH4; Henry H. Ting, MD, MBA4; Bo Hu, PhD5; Brian J. Zikmund-Fisher, PhD6,7
[+] Author Affiliations
1Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
2Department of Psychological Sciences, University of Missouri–Columbia
3Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts
4Knowledge and Evaluation Research Unit, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
5Quantitative Health Sciences Institute, Cleveland Clinic, Cleveland, Ohio
6Department of Health Behavior and Health Education, University of Michigan, Ann Arbor
7Department of Internal Medicine, University of Michigan, Ann Arbor
JAMA Intern Med. 2014;174(10):1623-1629. doi:10.1001/jamainternmed.2014.3331.
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Importance  For stable angina, the benefits of percutaneous coronary intervention (PCI) are limited to symptom relief, but patients often believe that PCI prevents myocardial infarction (MI). Whether presenting accurate information about the benefits of PCI would dispel these beliefs remains unknown. We hypothesized that explanatory information would be more effective for influencing volunteers’ beliefs.

Objective  To assess the effect of explicit and explanatory information on participants’ beliefs about PCI and their willingness to choose it.

Design, Setting, and Participants  We conducted a randomized trial in 2012 among adults older than 50 years living in the general community. We recruited participants using the Internet.

Interventions  Participants read 1 of 3 scenarios in which they experienced class I angina and were referred to a cardiologist. The cardiologist provided no information about the effects of PCI on MI risk, a specific statement that PCI does not reduce MI risk, or an explanation of why PCI does not reduce MI risk.

Main Outcomes and Measures  Participants’ beliefs about the benefit of PCI and choice of PCI and medication.

Results  A total of 1257 participants (90.0%) completed the survey; 54.5% chose PCI. Compared with those receiving explicit and explanatory information, those receiving no information were most likely to believe that PCI prevents MI (71.0% vs 38.7% vs 30.6%, respectively; P < .001), most likely to choose PCI (69.4% vs 48.7% vs 45.7%, respectively; P < .001), and least likely to agree to medication therapy (83.1% vs 87.4% vs 92.3%, respectively; P < .001). Across the entire sample, the decision to have PCI was strongly correlated with the belief that PCI would prevent MI (odds ratio, 5.82 [95% CI, 4.13-8.26]) and that the participant would feel less worried (odds ratio, 5.36 [95% CI, 3.87-7.45]), but was not associated with how much participants were limited by symptoms.

Conclusions and Relevance  In the setting of mild, stable angina, most people assume PCI prevents MI and are likely to choose it. Explicit information can partially overcome that bias and influence decision making. Explanatory information was the most effective intervention in overcoming this bias.

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Figure 1.
Patient Beliefs Concerning Percutaneous Coronary Intervention (PCI) and Medication

Participants were asked if they believe PCI will prevent a myocardial infarction (MI), if they would choose to have PCI, and if they would choose to take optimal medical therapy (OMT). Responses are stratified by information group. Error bars indicate 95% confidence intervals.

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Figure 2.
Patient Recollection of Cardiologist Statements About the Effect of Percutaneous Coronary Intervention (PCI)

Respondents in each information group are stratified by those who recalled the cardiologist stating that PCI decreases the risk for myocardial infarction, stating nothing, and stating that the risk would not change.

aCorrect answer.

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