Es. Holmboe et al., Perceptions of benefit and risk of patients undergoing first-time electivepercutaneous coronary revascularization, J GEN INT M, 15(9), 2000, pp. 632-637
OBJECTIVE: To assess reasons why patients undergo elective percutaneous cor
onary revascularization (PCR), patient expectations of the benefits of PCR,
and their understanding of the risks associated with PCR, We hypothesized
that patients overestimate the benefits and underestimate the risks associa
ted with PCR.
DESIGN:A prospective, semistructured questionnaire.
PARTICIPANTS: Patients undergoing their first elective PCR.
MAIN RESULTS: Fifty-two consecutive patients with a mean age of 64.3 years
(range 39-87) completed the interview. Although 30 (57%) patients cited rel
ief of symptoms as at least 1 reason to have PCR, 32 (62%) patients cited e
ither an abnormal diagnostic test result (i.e., exercise stress test or cat
heterization) or "pathophysiologic" problem (i.e., "I have a blockage"), wi
th 17 patients (33%) citing these reasons alone as indications for PCR. Thi
rty-nine (75%) patients believed PCR would prevent a future myocardial infa
rction, and 37 (71%) patients felt PCR would prolong their life. Regarding
the potential complications, only 24 patients (46%) could recall at least 1
possible complication. However, on a Deber questionnaire, the majority of
patients (67%) stated that they should determine either mostly alone or equ
ally with a physician how acceptable the risks of the procedure are for the
mselves.
CONCLUSIONS: The majority of patients had unrealistic expectatations about
the long-term benefits of elective PCR and was not aware of the potential r
isks, even though they expressed a strong interest in participating in the
decision to have PCR. More work is needed to define the optimal strategy to
educate patients about the benefits and risks of elective PCR, and whether
such education will affect patient decision making.