Session number: 1105
Abstract title: Do cardiologists beleive patient social and behavioral factors should influence receipt of PTCA/CABG
Author(s):
M van Ryn - Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center and
Associate Professor, Division of Epi, U of Minnesota SPH
Objectives: There has been extensive documentation of race/ethnicity disparities in treatments received for coronary disease. Moreover, recent evidence suggests that physicians perceptions of patients’ social and behavioral characteristics differ by race/ethnicity and socio-economic status of the patient. Although expert guidelines and criteria for appropriateness and necessity of revascularization absolutely omit consideration of patients social and behavioral characteristics, little is known about practicing physicians’ opinions regarding the role of these characteristics in treatment recommendations. Thus, the purpose of this study was to identify the degree to which practicing physicians believe coronary artery disease patients’ social and behavioral characteristics should influence treatment recommendations.
Methods: Self-administered questionnaires were sent to physicians treating a stratified random sample of patients who had received angiograms in one of 8 randomly selected New York State hospitals in 1995 and 1996. Respondents were asked to provide their opinion on the degree to which several characteristics should influence a patients’ likelihood for PTCA vs. Medicine, CABG vs medicine and CABG vs PTCA, if all other things were held equal The patient characteristics posed included substance abuse, a strong desire for a physically active lifestyle, major responsibilities for the care of family member, social isolation, and significant work demands. Sixty five percent (N=239) of the physicians sampled returned questionnaires. Of these , 87% were male and 75% white, with the largest minority group self-identifying as Asian (15%). Respondents ranged in age from 29 to 79, with a sample mean of 46 Three-fourths of the respondents were cardiologists, with the rest cardiac surgeons and primary care physicians.
Results: For each of the five characteristics and 3 treatment choices (PTCA vs. medication only, CABG vs. medication only, CABG vs. PTCA) the majority of respondents reported believing that the characteristic should influence treatment likelihood. Results ranged from 92% of respondents reporting the opinion that a patient’s desire to participate in physical activity should influence likelihood for CABG vs. Medication to 51% reporting that care for a family member should influence the choice of CABG vs. PTCA. There were minor subgroup variations in opinions which will be presented.
Conclusions: Despite the fact that neither the criteria developed by the Rand Corporation nor the American College of Cardiology criteria for appropriateness of revascularization include patients’ social or behavioral characteristics, the majority of practicing physicians in this sample report believing otherwise.
Impact statement: These findings illustrate a significant disconnect between expert panel guidelines and perspectives of practicing physicians. This reinforces the need for explicit discussion of and consensus development regarding the role of social and behavioral characteristics in treatment decisions. The implications of the findings will be discussed in light of the recent evidence that race/ethnicity and SES of patients influence physicians’ perceptions of patients social and behavioral characteristics and documented disparities in treatment provided.