A randomized controlled trial of information-giving to patients referred for coronary angiography: effects on outcomes of care

Objective To assess the impact of providing an educational videotape, ` Treatment Choices for Ischaemic Heart Disease: a Shared Decision-Making Program Videotape ,' to patients referred for coronary angiography compared with standard patient-physician decision making (usual care).
Study design Randomized controlled clinical trial.
Setting University Hospital and Veterans Affairs Hospital.
Patients A consecutive sample of 217 patients referred for coronary angiography were randomized to receive `usual care' or to receive the videotape in addition to standard patient physician decision making (videotape): 109 completed the study (50% completion rate).
Main outcome measures Knowledge of coronary artery disease, satisfaction, self-reported physical and mental health functioning, and the proportion of patients who were referred for coronary revascularization.
Results Compared with patients who received `usual care,' those who received the videotape were more knowledgeable (mean score 83 vs. 58%; P  < 0.0001) but less satisfied with their treatment (79 vs. 88%; P  = 0.038). There were no significant differences between the videotape and `usual care' groups with respect to satisfaction with the decision making process (mean score 73 vs. 77%; P  = 0.37), satisfaction with the decision made (mean score 73 vs. 78%; P  = 0.28), physical functioning (38 vs. 38%; P  = 0.76), mental health functioning (49 vs. 49%; P  = 0.94), or in referral for coronary revascularization (OR 0.60; 95% CI 0.22–1.65; P  = 0.33).
Conclusion Although the educational videotape increased patients' knowledge level, it was associated with a decrease in their level of satisfaction with treatment. Before there is wide-spread dissemination of this technology, advocates should demonstrate its effectiveness in everyday practice.