Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease

J Gen Intern Med. 2000 Oct;15(10):685-93. doi: 10.1046/j.1525-1497.2000.91139.x.


Objective: To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decision-making process involving treatment choices for ischemic heart disease, on patient decision-making.

Design: Randomized, controlled trial.

Setting: The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada.

Participants: Two hundred forty ambulatory patients with

Measurements and main results: The primary outcome was patient satisfaction with the decision-making process. This was measured using the 12-item Decision-Making Process Questionnaire that was developed and validated in a randomized trial of the benign prostatic hyperplasia SDP. Secondary outcomes included patient knowledge (measured using 20 questions about knowledge deemed necessary for an informed treatment decision), treatment decision, patient-angiographer agreement on decision, and general health scores. Outcomes were measured at the time of treatment decision and/or at 6 months follow-up. Shared decision-making program scores were similar for the intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, -3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the controls; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the intervention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were not different between the groups at 6 months. Exposure to the IHD SDP resulted in more patient-angiographer disagreement about treatment decisions.

Conclusions: There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decision-making autonomy without apparent impact on quality of life.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Confidence Intervals
  • Coronary Angiography
  • Decision Support Techniques*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Myocardial Ischemia / therapy*
  • Ontario
  • Patient Satisfaction
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Videodisc Recording*