• John A Spertus, Richard Bach, Charles Bethea, Adnan Chhatriwalla, Jeptha P Curtis, Elizabeth Gialde, Mayra Guerrero, Kensey Gosch, Philip G Jones, Aaron Kugelmass, Bradley M Leonard, Edward J McNulty, Marc Shelton, Henry H Ting, and Carole Decker.
• Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO. Electronic address: spertusj@umkc.edu.
• Am. Heart J. 2015 Feb 1;169(2):234-241.e1.

BackgroundWhile the process of informed consent is designed to transfer knowledge of the risks and benefits of treatment and to engage patients in shared medical decision-making, this is poorly done in routine clinical care. We assessed the impact of a novel informed consent form for percutaneous coronary intervention (PCI) that is more simply written, includes images of the procedure, and embeds individualized estimates of outcomes on multiple domains of successful informed consent and shared decision-making.MethodsWe interviewed 590 PCI patients receiving traditional consent documents and 527 patients receiving novel ePRISM consents at 9 US centers and compared patients' perceptions, knowledge transfer, and engagement in medical decision-making. Heterogeneity across sites was assessed and adjusted for using hierarchical models.ResultsSite-adjusted analyses revealed more frequent review (72% for ePRISM vs 45% for original consents) and better understanding of the ePRISM consents (ORs=1.8-3.0, depending upon the outcome) with marked heterogeneity across sites (median relative difference [MRD] in the ORs of ePRISM's effect =2-3.2). Patients receiving ePRISM consents better understood the purposes and risks of the procedure (ORs=1.9-3.9, MRDs=1.1-6.2), engaged more in shared decision-making (proportional OR=2.1 [95% CI=1.02-4.4], MRD=2.2) and discussed stent options with their physicians (58% vs. 31%; site-adjusted odds ratio=2.7 [95% CI=1.2, 6.3], MRD=2.6) more often.ConclusionsA personalized consent document improved the process of informed consent and shared decision-making. Marked heterogeneity across hospitals highlights that consent documents are but one aspect of engaging patients in understanding and participating in treatment.Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

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