Impact of an interactive video on decision making of patients with ischemic heart disease

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Abstract
An experimental pilot study using repeated measures to examine the impact of an interactive video program on the decision making of patients with ischemic heart disease was carried on at a tertiary care center and a Veterans Affairs hospital. The patients (n=60, mean age 61.1 years, 77% male, 75% white, 26.7% with acute myocardial infarction), who had undergone diagnostic cardiac catheterization and were found to have significant coronary artery disease (≥75% stenosis in at least one vessel), watched the Shared Decision-Making Program (SDP) for Ischemic Heart Disease (IHD), a novel interactive video system designed to provide information necessary for patients to participate actively in decision making. This program compares medical therapy, angioplasty, and bypass surgery through a physician narrator, patient testimonials, and empirically-based, patient-specific outcome estimates of short-time complications and long-term survival. Before and after viewing the SDP, patients completed surveys containing multiple choice questions and Likert scales. They rated the program as more helpful than all other decision aids except the physician, and after viewing the SDP they expressed increased confidence in their treatment choice and decreased confidence in alternative options (p=.0001). The greatest effects appeared to be concentrated in those patients with less education (p=.04), and the program appeared to increase anxiety in nonwhite patients compared with white patients (p=0.07).