• Michael B Rothberg, Senthil K Sivalingam, Reva Kleppel, Marc Schweiger, Bo Hu, and Karen R Sepucha.
• Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
• JAMA Intern Med. 2015 Jul 1; 175 (7): 1199-206.

ImportancePatients with stable coronary disease undergoing percutaneous coronary intervention (PCI) are frequently misinformed about the benefits of PCI. Little is known about the quality of decision making before angiography and possible PCI.ObjectiveTo assess the quality of informed decision making and its association with patient decisions.Design, Setting, And ParticipantsWe performed a cross-sectional analysis of recorded conversations between August 1, 2008, and August 31, 2012, among adults with known or suspected stable coronary disease at outpatient cardiology practices.Main Outcomes And MeasuresPresence of 7 elements of informed decision making and the decision to undergo angiography and possible PCI.ResultsOf 59 conversations conducted by 23 cardiologists, 2 (3%) included all 7 elements of informed decision making; 8 (14%) met a more limited definition of procedure, alternatives, and risks. Specific elements significantly associated with not choosing angiography and possible PCI included discussion of uncertainty (odds ratio [OR], 20.5; 95% CI, 2.3-204.9), patient's role (OR, 5.3; 95% CI, 1.3-21.3), exploration of alternatives (OR, 9.5; 95% CI, 2.5-36.5), and exploration of patient preference (OR, 4.8; 95% CI, 1.2-19.4). Neither the presence of angina nor severity of symptoms was associated with choosing angiography and possible PCI. In a multivariable analysis using the total number of elements as a predictor, better informed patients were less likely to choose angiography and possible PCI (OR per additional element, 3.2; 95% CI, 1.4-7.1; P = .005).Conclusions And RelevanceIn conversations between cardiologists and patients with stable angina, informed decision making is often incomplete. More complete discussions are associated with patients choosing not to undergo angiography and possible PCI.

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