Abstract 256: Information-Seeking Behavior among Medicare Patients with Stable Coronary Artery Disease

Abstract

Introduction: Active participation of informed patients in medical decision-making is an essential component of high quality patient-centered care, particularly for individuals undergoing elective cardiac procedures. Prior studies have shown that patients have significant misperceptions about elective cardiac procedures; however, it is not known where individuals obtained the information used for making such decisions. Therefore we explored the sources of information used and their relative importance in patients with CAD who underwent an elective cardiac procedure. Methods: We analyzed data from a national cross-sectional survey of randomly sampled Medicare beneficiaries who had an elective coronary artery bypass (CABG) surgery or percutaneous coronary intervention (PCI) in 2008. The survey contained questions assessing demographics, cardiac history, the decision-making process, knowledge, and information sources. Information sources reported were the physician, media, friends and family, and the internet. We analyzed the use of each source and the relative importance of sources. We also performed logistic regression with each source as an outcome to determine characteristics that influenced whether a source was important. Results: The survey response rate was 78% (1110/1421). After exclusions, 927 surveys were included in the analysis. Of the 865 patients (93.3%, 865/927) who reported their physician was a source of information, 91.1% (788/865) felt their physician was “very” or “extremely” important. The doctor was the only source of information for 27% (253/927) of participants, and white respondents were more likely than non-whites to rely only on the doctor (OR 3.04, 95% CI 1.46, 6.33). Although 44.4% (412/927) of respondents reported obtaining information from the media, only 20.9% (86/412) of that group rated the media as “very” or “extremely” important. A total of 72.9% (676/927) of respondents cited family and friends as a source of information; 49.1% (332/676) of those rated them as “very” or “extremely” important. White respondents were less likely than non-whites to value the media (OR 0.36, 95% CI 0.19, 0.68) and family and friends as a source (OR 0.42, 95% CI 0.25, 0.70). Only 12.1% (112/927) of the sample reported using the internet for information, but of those who did, 47.3% (53/112) rated it “very” or “extremely” important. Participants who graduated from college (OR 4.22, 95% CI 1.49, 11.9) and those who were under 75 (OR 2.00, 95% CI 1.08, 3.71) were more likely to value the internet as a source. Conclusion: Among Medicare patients with stable CAD who have had CABG or PCI, the physician is consistently perceived as the most important source of information. Some patients also look to other sources, but the additional information is not as highly-valued as information from the physician. Therefore physicians should be aware that they are patients' primary source of information in deciding whether to undergo elective cardiac procedures. Providers should aim to provide high quality information to ensure that patients are well-informed and able to actively participate in the decision-making process.