A new study’s findings indicate that most patients do not understand or recall information given to them by health care providers before heart procedures. Many mistakenly believe that opening blocked arteries will cure them of heart disease. These findings, from a study taking a look at informed consent, are published in the Nov. 28 issue of the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC).
The researchers noted that more than 40 percent of the patients in the study acknowledged that they do not understand, or remember, the information they receive about percutaneous coronary intervention (PCI) that has become the most common intervention performed in high- and middle-income countries.
According to the researchers, providing details about a procedure, including the risks and benefits, is a legal and ethical requirement – referred to as informed consent. Patients should receive enough information about their options to make a valid choice, without being coerced, they say. Health professionals must also confirm that the patient has sufficient capacity to decide at that time.
Misunderstanding the Benefits of Treatment Choices
In this study, the participating patients who were asked about the consent process were treated with either elective, or urgent PCI, but not emergency PCI when speed is of the essence. Some 60 percent of patients with coronary heart disease undergoing elective PCI to unblock an artery thought it would cure their coronary heart disease, note the researchers. Nearly 95 percent of the patients believed it would reduce their risk of a future heart attack and 91 percent thought it would increase their life span.
“These beliefs do not align with trial evidence, which shows that elective PCI is predominantly for relief of symptoms,” said Professor Felicity Astin, University of Huddersfield, UK, in a statement detailing the study’s results.
Astin said health services should be reconfigured to allow sufficient time for patients and clinicians to discuss the proposed treatment and potential alternatives. She adds: “Patients often receive all of the information at once. They then feel overloaded, which contributes to forgetting or not comprehending what they hear.”
Nearly half (47 percent) would have liked a family member with them when their treatment was explained during the informed consent process. Almost 31 percent of patients in the study needed some degree of help to understand health-related written information. “Health literacy is a neglected issue. Leaflets should be in plain language,” says Astin.
Astin adds, “clinicians should ask patients if they need help reading or understanding health information. Patients will not volunteer that they can’t read.”
The researchers called for both for patients and health professionals to work together to develop and evaluate new approaches to information sharing and decision-making Astin recommends that cardiologists and nurses receive training to use ‘teach back’ that is giving small chunks of information then asking patients to explain it in their own words to see how much they have understood.
Astin says: “The emphasis is on being a good teacher, not testing the patient and making them feel ashamed. But staff can only do this if they have the time – which is why patient pathways need to be configured.”