Northwest Health Winter 2011

Which Treatment Is Best?

A patient discovers how shared decision-making aids can help with tough decisions.

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In 2001, Larry Bell's chest pain resulted in an emergency visit to the hospital where tests revealed that he needed bypass surgery for his coronary artery disease. Several of his arteries were narrowed or blocked by the fatty deposits known as plaque.

Bell was told that although bypass surgery is done frequently, it's still a complex procedure with a lengthy recovery time and the potential for serious complications. But it was his best treatment choice since his coronary artery disease was advanced.

Not all cases of coronary artery disease are as clear cut. Sometimes, opening a blocked artery with angioplasty and stents — less invasive than bypass — are a possibility. Other times, medications might be an effective option.

When Bell recently experienced chest pain again, a second bypass surgery wasn't his only choice. This time, his Group Health Physicians cardiologist Nathan Green, MD, recommended an educational decision-making aid to help Bell understand his options.

Helping you decide. Group Health has shared decision-making aids for 12 health conditions in 6 specialty areas: orthopedics, women's health, urology, back care, breast cancer, and cardiac care. The aids are most helpful when one treatment is likely to have a similar outcome to another. They come as DVDs, or videos streamed online from MyGroupHealth. A companion booklet is available for both formats.

"Having this information allows you to have a better discussion with your doctor," says Bell of his experience with the decision aid. Michael Soman, MD, president and chief medical executive of Group Health Physicians comments, "Research shows that when patients are better informed of their options, results are better for many conditions."

Dr. Green offers these decision aids to patients whose symptoms aren't changing. Heart patients who wind up in the hospital emergency room are usually in a health crisis, as Bell was when his bypass surgery was performed. "In those patients with unstable symptoms, it can be safer to open up a blockage rather than try medications to see if they work first," notes Dr. Green.

How it works for coronary artery disease. The coronary artery disease decision aid gives patients information about the pros and cons of medication, stents, and bypass surgery. They learn that medication may control pain, but may trigger unpleasant side effects. Stents may be a good option for patients with one or two blockages, but not for someone with more blockages. Bypass surgery has higher risks, but is good for multiple blockages.

Each case of coronary artery disease is unique, of course. And that's why the doctor-patient discussion is so important. "Age, severity of symptoms, location of blockages, and other health conditions, as well as patient values and preferences, must be weighed in reaching an individualized treatment decision," says Dr. Green.

For Bell, when he learned that he could try medication to control pain instead of a second bypass surgery, that's what he decided to do. "So far, everything is fine," he says.

But if the medication stops working, or he doesn't tolerate it well, he and Green can reconsider that decision. "About 30 percent of the time the medicines don't work to control symptoms, and a procedure to open the blockage is needed," says Dr. Green.

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