Randomized, controlled trial of on interactive videodisc decision aid for patients with ischemic heart disease

OBJECTIVE: To determine the effect of the Ischemic Heart Disease Shared Dec ision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decisionmaking process involving treatment choices for isch emic heart disease, on patient decision-making. DESIGN:Randomized, controlled trial. SETTING: The Toronto Hospital, University of Toronto, Toronto, Ontario, Can ada. PARTICIPANTS: Two hundred forty ambulatory patients with ischemic heart dis ease amenable to elective revascularization and ongoing medical therapy. MEASUREMENTS AND MAIN RESULTS: The primary outcome was patient satisfaction with the decision-making process. This was measured using the la-item Deci sion-Making Process Questionnaire that was developed and validated in a ran domized trial of the benign prostatic hyperplasia SDP. Secondary outcomes i ncluded patient knowledge (measured using 20 questions about knowledge deem ed necessary for an informed treatment decision), treatment decision, patie nt-angiographer agreement on decision, and general health scores, Outcomes were measured at the time of treatment decision and/or at 6 months follow-u p. Shared decision-making program scores were similar for the Intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, -3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the con trols; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the inter vention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were no t different between the groups at 6 months. Exposure to the IHD SDP resulte d in more patient-angiographer disagreement about treatment decisions. CONCLUSIONS: There was no significant difference in satisfaction with decis ion-making process scores between the IHD SDP and usual practice groups. Th e IHD SDP patients were more knowledgeable, underwent less revascularizatio n (interventional therapies), and demonstrated increased patient decisionma king autonomy without apparent impact on quality of life.