ArticleJournal of general internal medicine2021
Patient Risk Interpretation of Symptoms Model (PRISM): How Patients Assess Cardiac Risk.
Article in Journal of general internal medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors at 5 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundWhile there is a prevailing perception that coronary artery disease (CAD) is a "man's disease," little is known about the factors which influence cardiac risk assessment and whether it varies by gender.
objectives1) Qualitatively capture the complexity of cardiac risk assessment from a patient-centered perspective. 2) Explore how risk assessment may vary by gender. 3) Quantitatively validate qualitative findings among a new sample.
designThis study was conducted in two parts: (1) semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analyzed using modified grounded theory; (2) emergent themes were surveyed in a separate sample to validate findings quantitatively. Differences were estimated using 2-tailed t-tests and kappa.
participantsParticipants who were referred for their first elective coronary angiogram for suspected CAD with at least 1 prior abnormal test were recruited from a tertiary care hospital. MAIN MEASURES: Patient-centered themes were derived from part one. In part two, patients estimated the probability that their symptoms were heart-related at multiple time points.
resultsPart 1 included 14 men and 17 women (mean age=63.3±11.8 years). Part 2 included 237 patients, of which 109 (46%) were women (mean age=66.0±11.3 years). Part 1 revealed that patients' risk assessment evolves in three distinct phases, which were captured using an Ishikawa framework entitled "Patient Risk Interpretation of Symptoms Model" (PRISM). Part 2 validated PRISM findings; while patients were more likely to attribute their symptoms to CAD over time (phase 1 vs. 3: 21% vs. 73%, p<0.001), women were marginally less likely than men to perceive symptoms as heart-related by phase 3 (67% women vs. 78% men, p=0.054).
conclusionsPatient assessment of CAD risk evolves, and women are more likely to underestimate their risk than men. PRISM may be used as a clinical aid to optimize patient-centered care. Future studies should validate PRISM in different clinical settings.
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