Abstract
Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.
Highlights
Acute chest pain accounts for approximately 700,000 emergency department (ED) attendances each year in England and Wales (Goodacre et al, 2005), but between 30 and 60% of these patients do not receive a cardiac diagnosis (Eken et al, 2010; Mayou & Thompson, 2002)
Interviews with non-cardiac chest pain (NCCP) patients who were experiencing continued anxiety and chest pain highlighted a lack of understanding of their chest pain (Webster, Thompson, & Norman, 2015). These findings indicate that, contrary to previous suggestions (Esler & Bock, 2004), NCCP patients may be accepting of psychological explanations, and open to psychological interventions
Four specialist chest pain nurses participated in the focus group (100% female; aged 29–50)
Summary
A stepped approach to treatment has been proposed (Kisely et al, 2012; Mayou, Bass, & Bryant, 1999) with self-help forming an initial step (Hirai & Clum, 2006). Such materials have been effective for anxiety disorders (Lewis, Pearce, & Bisson, 2012) and may be useful within this setting (Esler et al, 2003). Brief information leaflets for chest pain patients within the ED have been shown to have an effect on psychological outcomes but no impact on chest pain (Arnold, Goodacre, Bath, & Price, 2009). The need for brief interventions that impact on both psychological and physical outcomes is apparent
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