Quantifying Patient-Physician Communication and Perceptions of Risk During Admissions for Possible Acute Coronary Syndromes - 20/06/15
, Kaushal H. Shah, MD aAbstract |
Study objective |
Disposition decision for patients with possible acute coronary syndrome in the emergency department (ED) is driven primarily by perception of short-term risks. We sought to evaluate communication between patient and physician about these risks by ascertaining the content of discussions surrounding disposition decision.
Methods |
We conducted matched-pair surveys of patients admitted for possible acute coronary syndrome and their physicians in 2 academic, inner-city EDs. After disposition conversation, trained research assistants administered surveys querying perceived and communicated risk estimates and purpose of admission. Primary exclusion criteria were ECG or troponin value diagnostic of acute coronary syndrome. The primary outcome measure was agreement in assessment of the risk of myocardial infarction, defined as the proportion of patient-physician pairs whose risk estimates were within 10% of each other.
Results |
A total of 425 patient-physician survey pairs were collected. Fifty-three percent of patients were men. Patients reported discussing the likelihood of their symptoms’ being due to myocardial infarction in 65% of cases, whereas physicians reported this in 46%. After their discussion, physicians’ (n=415) median estimate of short-term risk was 5% (95% confidence interval [CI] 3% to 7%), whereas patients’ (n=401) was 8% (95% CI 5% to 11%). Most patients (63%; 95% CI 57% to 67%) reported that this estimate remained the same or increased after their conversation. Risk agreement within 10% occurred in 36% of cases (n=404; 95% CI 32% to 41%). Patients’ median estimates of the mortality of myocardial infarction at home versus in the hospital were 80% (n=398; 95% CI 76% to 84%) and 10% (n=390; 95% CI 7% to 13%), respectively, whereas physician estimates were 15% (n=403; 95% CI 12% to 18%) and 10% (n=398; 95% CI 7% to 13%).
Conclusion |
Our survey demonstrates poor communication, with overestimation of both the risks of myocardial infarction and potential benefit of hospital admission. These findings suggest that communication surrounding disposition decisions in chest pain patients may at times be ineffective or misleading.
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| Please see page 14 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Deborah B. Diercks, MD |
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| Author contributions: DHN and KHS were responsible for study conception and design. DHN, BA, MLH, ML, AM, AS, and KHS were responsible for execution of the study. DHN, BA, and DTS were responsible for data analysis. DHN, PM, and KHS were responsible for article preparation. BA, MLK, ML, AM, and AS were responsible for data collection. DTT was responsible for database management. DHN takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 66 - N° 1
P. 13 - juillet 2015 Retour au numéro
Article précédent
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