A Qualitative Study Eliciting Patient Preferences For Cabg Vs Pci

Abstract

Eliciting patient preferences and goals of care are foundational to the shared decision-making process and are also important to consider in clinical trial design. This qualitative study was part of formative work of a planning study to determine optimal design for a future randomized clinical trial comparing revascularization with coronary artery bypass grafting vs. percutaneous coronary intervention in patients with ischemic cardiomyopathy. Objective: To elicit patient preferences for CABG vs. PCI among ischemic heart disease patients for use in refining study design and methods. Methods: We conducted individual interviews and focus groups with 20 subjects (>age 18) with ischemic cardiomyopathy to elicit patient attitudes and descriptions of patient preferences for treatment option. A semi-structured interview guide that included open-ended questions "What is the most important thing you consider when⋯" provided structure but allowed participants to communicate attitudes and patient preferences. All interviews and focus groups were audiotaped and transcribed verbatim; and analyzed using Atlas ti v 8.0 to identify attributes and levels of attributes that influence decision making. Results: Among this sample of patients with ischemic cardiomyopathy (85% male; 80% non-hispanic White); patients described that they are most likely to take the advice of their trusted provider "he's the expert and he knows my case⋯I do what he says". Five attributes of patient preferences emerged: invasiveness, quality of life, sustainability, complications and recovery period. In each category, subjects described 3 levels of attributes they deemed as influential (e.g., critical, major or minor complication). They also described preferences as a trade off or balancing of attributes. For example trading a longer recovery period for sustainability "If I'm in the hospital longer, I'll manage⋯I prefer one and done!" Or balancing procedure invasiveness with impact to quality of life "I don't want to crack my chest but if it means I will play tennis again⋯". Conclusions: Preferences for CABG vs. PCI among ischemic heart disease patients provide important data for determination of study feasibility, entry criteria and recruitment strategies to support planning of a future clinical trial.