Patients’ Expectations About Effects Of PCI For Stable Coronary Artery Disease And Related Factors Analysis

Objective To explore the patients’ expectations about effects of PCI for stable coronary artery disease and to investigate various factors in relation to the expectations such as complete cure of the disease, extend life, prevent future myocardial infarction or reinfarction, alleviate the symptoms of angina.Methods A total of 635 patients diagnosed stable coronary artery disease in three tertiary hospitals were investigated with general information questionnaire, Control Preference Scale(CPS), The Patient-Doctor Relationship Scale(PDRQ-13), European Quality of Life-5 Dimensions (EQ-5D). Response options included " cure of the disease", "extend life", "prevent infarction or reinfarction", "symptom relief" and "others". The possible answers ranged from " not at all likely", " a little likely ", "somewhat likely", "very likely" and "don’t know or unsure ". SPSS 17.0 statistical software was used to analyze data, including descriptive statistical analysis,χ2 test and binary logistic regression analysis.Results1 Overall,78.4% of patients with stable coronary artery disease did not report understanding that PCI was not at all likely to cure their disease,88.3% did not report understanding that PCI was not at all likely to extend their life,83.8% did not report understanding that PCI was not at all likely to prevent infarction or reinfarction, while 90.9% correctly reported that PCI would alleviate the symptoms of angina, only 1.7% identified this as the only benefit from this treatment.2.5% expected PCI would let their old age more happiness,2.8% expected PCI would avoid coronary artery bypass surgery and 1.4% expected PCI would lead a healthy life style.2 x2 test showed that the influencing factors of patients who tended to expect PCI would cure their disease were gender (χ2=13.866, P<0.01), age (χ2=18.423, P<0.01), residence(χ2=11.989, P<0.01)、education(χ2=20.173, P<0.01), household income(χ2=8.778, P<0.05), information sources of PCI(χ2=11.35, P<0.05), physical function (χ2=7.103, P<0.01), control preference (χ2=9.443, P<0.01) and the patient-doctor relationship (χ2=11.814, P<0.01). Multivariate analysis with Enter binary logistic regression showed that independent predictors for this expectation were gender (OR=3.102,95%CI 1.808～5.322),age (OR=0.484,95%CI 0.343～ 0.684), education (OR=0.486,95%CI 0.370～0.637), information from the network (OR=0.390,95%CI 0.212～0.717) and the patient-doctor relationship (OR=1.576, 95%CI 1.198～2.073)3 x2 test showed that the influencing factors of patients who tended to expect PCI would extend their life were gender (χ2=4.002, P<0.05), age(χ2=7.859, P<0.05), education (χ2=12.316, P<0.01), household income (χ2=9.102, P<0.05), physical function (χ2=4.48, P<0.05) and the patient-doctor relationship (x2=26.099, P<0.01). Multivariate analysis with Enter binary logistic regression showed that independent predictors for this expectation were gender (OR=2.099,95%CI 1.090～4.042), age (OR=0.428,95%CI 0.279～0.659) education (OR=0.491,95%CI 0.352～0.684), household income (OR=1.419,95%CI 1.025～1.964) and the patient-doctor relationship (OR=1.909,95%CI 1.385～2.630)4 x2 test showed that the influencing factors of patients who tended to expect PCI would prevent future myocardial infarction or reinfarction were age (χ2=21.732, P<0.01), education (χ2=21.46, P<0.01), the type of payment (χ2=4.947, P<0.05), information sources of PCI (χ2=17.358, P<0.01), physical function (χ2=14.879, PO.01), control preference (χ2= 13.205, P<0.01) and the patient-doctor relationship (χ2=8.924, P<0.05). Multivariate analysis with Enter binary logistic regression showed that independent predictors for this expectation were education (OR=0.552, 95%CI 0.413～0.739), information from the network (OR=0.325,95%CI 0.176～ 0.601), physical function (OR=2.289,95%CI 1.309～4.005) and the patient-doctor relationship (OR=1.614,95%CI 1.210-2.154)Conclusions1 A large population of patients with stable coronary artery disease had unrealistic expectations about the effects of PCI, which could compromise their ability to make informed treatment decisions that were consonant with their preferences.2 Factors such as females, younger age, low level of education were significantly associated with the likelihood of an inaccurate response about the curative potential of PCI.3 Females, younger age, low level of education and higher household income were significantly associated with the likelihood of an inaccurate response that PCI would extend their life.4 Low level of education and poor physical function were significantly associated with the likelihood of an inaccurate response that PCI would prevent future myocardial infarction or reinfarction.5 Patients who had the better relationships with doctors were at higher risk for inaccurate expectations, whereas patients receiving their informations of PCI from networks appeared to be at somewhat lower risk.6 The quality of communication of expectations about effects of PCI should be improved urgently. The role of clinicians is to effectively identify the high incidence of unrealistic expectations and communicate clearly with the patients, accurately convey technical information and the risks and benefits associated with this procedure could help to minimise misunderstandings between doctor and patient, so that patients can make fully informed decisions that are aligned with the their personal goals and values.