Abstract
BackgroundChest pain is a common presenting complaint in the emergency department (ED). Despite the frequency with which clinicians evaluate patients with chest pain, accurately determining the risk of acute coronary syndrome (ACS) and sharing risk information with patients is challenging. The aims of this study are (1) to develop a decision aid (CHEST PAIN CHOICE) that communicates the short-term risk of ACS and (2) to evaluate the impact of the decision aid on patient participation in decision-making and resource use.Methods/DesignThis is a protocol for a parallel, 2-arm randomized trial to compare an intervention group receiving CHEST PAIN CHOICE to a control group receiving usual ED care. Adults presenting to the Saint Mary's Hospital ED in Rochester, MN USA with a primary complaint of chest pain who are being considered for admission for prolonged ED observation in a specialized unit and urgent cardiac stress testing will be eligible for enrollment. We will measure the effect of CHEST PAIN CHOICE on six outcomes: (1) patient knowledge regarding their short-term risk for ACS and the risks of radiation exposure; (2) quality of the decision making process; (3) patient and clinician acceptability and satisfaction with the decision aid; (4) the proportion of patients who decided to undergo observation unit admission and urgent cardiac stress testing; (5) economic costs and healthcare utilization; and (6) the rate of delayed or missed ACS. To capture these outcomes, we will administer patient and clinician surveys after each visit, obtain video recordings of the clinical encounters, and conduct 30-day phone follow-up.DiscussionThis pilot randomized trial will develop and evaluate a decision aid for use in ED chest pain patients at low risk for ACS and provide a preliminary estimate of its effect on patient participation in decision-making and resource use.Trial registrationClinical Trials.gov Identifier: NCT01077037
Highlights
Chest pain is a common presenting complaint in the emergency department (ED)
Participant recruitment We have previously developed and validated an electronic notification system that is highly sensitive and specific for identifying potentially eligible participants presenting to the ED with chest pain as a primary complaint [9]
We have described the design of a clinical trial to determine the effectiveness of a decision aid on patient participation in decision-making and resource use in ED chest pain patients at low risk for acute coronary syndrome (ACS)
Summary
Despite the frequency with which clinicians evaluate patients with chest pain, accurately determining the risk of acute coronary syndrome (ACS) and sharing risk information with patients is challenging. The aims of this study are (1) to develop a decision aid (CHEST PAIN CHOICE) that communicates the short-term risk of ACS and (2) to evaluate the impact of the decision aid on patient participation in decision-making and resource use. Without the assistance of decision support tools, clinicians are challenged to precisely quantify risk and often resort to terms such as "low," "rare," or "uncommon" when communicating risk to patients. To increase patient understanding of risk and optimize knowledge transfer between physicians and patients, we will develop and evaluate a decision aid that includes a precise estimate of the short-term risk for ACS described using prose phrases, numbers, and a pictograph to account for patients' preferred mode of understanding numerical information
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