Atherosclerosis, Coronary Artery Disease
Conditions
Keywords
Coronary Angiogram, Decision Aid, Vascular Access, Radial, Femoral
Brief summary
Coronary angiogram (CA) procedures, with and without angioplasty, can be performed via vascular access in the wrist (radial artery) or leg (femoral artery). Both radial and femoral artery vascular access have their advantages and disadvantages, but neither has yet been proven to have superior health outcomes. Often patients are eligible for both access sites but are not well informed regarding the potential advantages and disadvantages of each site. Vascular access in cardiac catheterization can be considered a grey zone, where the benefits and harms may have different levels of significance depending on the individual's preferences and values. For example, patients with significant back pain may not prefer the femoral approach as it requires the patient to lie flay for an extended period of time compared to the radial approach. For grey zone health care options, Patient Decision Aids (PtDA) have been demonstrated to improve the quality of decision making by significantly improving knowledge of the patient's health care options, improving the patient's accurate risk perception, and improving value congruence with the chosen options. The investigators propose a randomized controlled trial (RCT) to evaluate the decision quality impact of a vascular access PtDA compared to usual care in eligible patient's undergoing elective CA procedures. If the PtDA is demonstrated to positively impact the decision quality of patients prior to CA procedures, it would be an invaluable bedside tool to promote patient informed medical decision making. Hypothesis: The investigators believe that a PtDA, when compared to usual care, will positively impact the decision quality and the process of decision making, relating to vascular access options in eligible patients undergoing elective CA procedures.
Interventions
BEHAVIORALVascular Access Decision Aid
The intervention group will receive a PtDA addressing vascular access for CA procedures. The PtDA is a brief lay summary that outlines, the purpose of the PtDA, a description of both femoral and radial approaches for CA procedures, what to expect from both approaches, the known risks/benefits of each access site (including a grading of the evidence), and a short assessment of the patients values. The values assessment is included in the PtDA as a means to help guide the patient through the decision making process. This section will ask the patient to explicitly state which features, risks, and benefits of each approach are important to them.
Sponsors
McMaster University
University of Ottawa
Hamilton Health Sciences Corporation
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age \> 18 years old * English speaking * able to provide informed consent * is able to read the English language (however, if a patient is not able to read due to visual impairment, they may still be considered for enrollment if a family member is present to read and relay the content of the PtDA) * candidates for both femoral and radial access as defined by the pre-assessment checklist and subsequently approved by their treating physician
Exclusion criteria
* any patients not meeting the inclusion criteria * the interventional cardiologist performing the procedure does not feel comfortable or believes the patient is ineligible for either access (may include reason's not specifically outlined in the pre-assessment checklist)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary outcome involves evaluation of the decision process leading to decision quality as assessed by the Decisional Conflict Scale (DCS). The DCS is a validated scale that has been used in more than 30 PtDA studies across different decisions. | 1 Day |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Improved value congruence with the patient's chosen option as assessed by a pre-discharge questionnaire. | 1 Day | — |
| Angiographic Success (PCI) as determined by interventionalist performing the procedure. | 1 day | Impact of patients choosing their vascular access with the help of a PtDA versus usual care as evidenced by various procedural outcomes |
| Improved knowledge and accurate risk perception of the patient's health care option assessed by a pre-discharge questionnaire. | 1 Day | — |
| Procedural time (minutes) | 1 day | Impact of patients choosing their vascular access with the help of a PtDA versus usual care as evidenced by procedural outcomes |
| Access site Complications (Significant bleeding, hematoma, pseudoaneurysm, or vascular compromise requiring intervention) | 1 day | Hematoma, bleeding, thrombosis |
| Vascular access success-ability to successfully gain vascular access through the selected site (radial versus femoral). | 1 Day | Impact of patients choosing their vascular access with the help of a PtDA versus usual care as evidenced by procedural outcomes |
Countries
Canada
Outcome results
None listed