Decision Making Characteristics and Preferences in Acute Myocardial Infarction Patients: Insights from PREMIER

2.50
Hdl Handle:
http://hdl.handle.net/10755/159329
Type:
Presentation
Title:
Decision Making Characteristics and Preferences in Acute Myocardial Infarction Patients: Insights from PREMIER
Abstract:
Decision Making Characteristics and Preferences in Acute Myocardial Infarction Patients: Insights from PREMIER
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2005
Author:Decker, Carole, PhD, RN
P.I. Institution Name:Mid America Heart Institute & University of Missouri - Kansas City
Title:Clinical Nurse Researcher
Contact Address:Cardiovascular Research, 4401 Wornall Road, Kansas City, MO, 64111, USA
Contact Telephone:816 932-5440
Co-Authors:Nina Worden, BA, Research Analyst; Karen Nugent, BS, RRT, Research Coordinator; Kimberly Reid, MS, Biostatistician; and John A Spertus, MD, MPH, Professor
Purpose: The Institute of Medicine has challenged healthcare delivery
to have patients be active in medical decision-making (MDM). We examined
the frequency and characteristics with which Acute Myocardial Infarction
(AMI) patients wish to assume an active role in decision making about
their treatment.
Theoretical/Conceptual Framework: Informed consent is the standard in
healthcare for decision making. BrodyÆs transparent conversation for
informed consent serves as the Conceptual framework for the study.
Subjects: PREMIER, an observational registry, prospectively enrolled 2,502
AMI patients at 19 centers.
Method: Patients' MDM preferences were quantified using a validated tool
based on decision-making categories of: "doctor alone", "mostly doctor" to "share equally" to "mostly patient (self)", and "patient (self)
alone". An active role was defined as "mostly self", "share equally", and
"self alone", while passive was defined as "doctor alone" and "mostly
doctor" along with a shared equally role. We examined demographic,
clinical, patient, and baseline health status data as they related to MDM
preferences using a multivariable logistic regression model.
Results & Conclusions: Overall, 69% of MI patients (n=1682/2448) responded
they wanted an active role in making decisions. Multivariable model
results illustrated the typical patient who wishes to have an active role
is: younger (Odds Ratio 0.8 per 10 years, 95% CI 0.72 to 0.83, p<0.0001);
more likely to be female (OR 1.6, 95% CI 1.33 to 1.99, p<0.0001); white
(OR 1.5, 95% CI 1.19 to 1.90, p=0.0007); college educated (OR 1.9, 95% CI
1.56 to 2.28, p<0.0001); and more likely to live on the West Coast as
opposed to the Midwest (OR 1.9, 1.34 to 2.69, p=0.012). There was no
difference is decision making preference for patients with CHF,
depression, or prior MI, PCI, or CABG. Preference for MDM was not
associated with patients' ultimate MI treatment (medical treatment vs. PCI
vs. CABG).
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDecision Making Characteristics and Preferences in Acute Myocardial Infarction Patients: Insights from PREMIERen_GB
dc.identifier.urihttp://hdl.handle.net/10755/159329-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Decision Making Characteristics and Preferences in Acute Myocardial Infarction Patients: Insights from PREMIER</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Decker, Carole, PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Mid America Heart Institute &amp; University of Missouri - Kansas City</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Researcher</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Cardiovascular Research, 4401 Wornall Road, Kansas City, MO, 64111, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">816 932-5440</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">c1decker@saint-lukes.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Nina Worden, BA, Research Analyst; Karen Nugent, BS, RRT, Research Coordinator; Kimberly Reid, MS, Biostatistician; and John A Spertus, MD, MPH, Professor</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The Institute of Medicine has challenged healthcare delivery <br/> to have patients be active in medical decision-making (MDM). We examined <br/> the frequency and characteristics with which Acute Myocardial Infarction <br/> (AMI) patients wish to assume an active role in decision making about <br/> their treatment. <br/> Theoretical/Conceptual Framework: Informed consent is the standard in <br/> healthcare for decision making. Brody&AElig;s transparent conversation for <br/> informed consent serves as the Conceptual framework for the study.<br/> Subjects: PREMIER, an observational registry, prospectively enrolled 2,502 <br/> AMI patients at 19 centers. <br/> Method: Patients' MDM preferences were quantified using a validated tool <br/> based on decision-making categories of: &quot;doctor alone&quot;, &quot;mostly doctor&quot; to &quot;share equally&quot; to &quot;mostly patient (self)&quot;, and &quot;patient (self) <br/> alone&quot;. An active role was defined as &quot;mostly self&quot;, &quot;share equally&quot;, and <br/> &quot;self alone&quot;, while passive was defined as &quot;doctor alone&quot; and &quot;mostly <br/> doctor&quot; along with a shared equally role. We examined demographic, <br/> clinical, patient, and baseline health status data as they related to MDM <br/> preferences using a multivariable logistic regression model.<br/> Results &amp; Conclusions: Overall, 69% of MI patients (n=1682/2448) responded <br/> they wanted an active role in making decisions. Multivariable model <br/> results illustrated the typical patient who wishes to have an active role <br/> is: younger (Odds Ratio 0.8 per 10 years, 95% CI 0.72 to 0.83, p&lt;0.0001); <br/> more likely to be female (OR 1.6, 95% CI 1.33 to 1.99, p&lt;0.0001); white <br/> (OR 1.5, 95% CI 1.19 to 1.90, p=0.0007); college educated (OR 1.9, 95% CI <br/> 1.56 to 2.28, p&lt;0.0001); and more likely to live on the West Coast as <br/> opposed to the Midwest (OR 1.9, 1.34 to 2.69, p=0.012). There was no <br/> difference is decision making preference for patients with CHF, <br/> depression, or prior MI, PCI, or CABG. Preference for MDM was not <br/> associated with patients' ultimate MI treatment (medical treatment vs. PCI <br/> vs. CABG).</td></tr></table>en_GB
dc.date.available2011-10-26T21:54:53Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T21:54:53Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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