Effectiveness of the chest pain choice decision aid in emergency department patients with low-risk chest pain: Study protocol for a multicenter randomized trial

Ryan T. Anderson, Victor M. Montori, Nilay D. Shah, Henry H. Ting, Laurie J. Pencille, Michel Demers, Jeffrey A. Kline, Deborah B. Diercks, Judd E. Hollander, Carlos A. Torres, Jason T. Schaffer, Jeph Herrin, Megan Branda, Annie Leblanc, Erik P. Hess

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16 Scopus citations

Abstract

Background: Chest pain is the second most common reason patients visit emergency departments (EDs) and often results in very low-risk patients being admitted for prolonged observation and advanced cardiac testing. Shared decision-making, including educating patients regarding their 45-day risk for acute coronary syndrome (ACS) and management options, might safely decrease healthcare utilization. Methods/Design: This is a protocol for a multicenter practical patient-level randomized trial to compare an intervention group receiving a decision aid, Chest Pain Choice (CPC), to a control group receiving usual care. Adults presenting to five geographically and ethnically diverse EDs who are being considered for admission for observation and advanced cardiac testing will be eligible for enrollment. We will measure the effect of CPC on (1) patient knowledge regarding their 45-day risk for ACS and the available management options (primary outcome); (2) patient engagement in the decision-making process; (3) the degree of conflict patients experience related to feeling uninformed (decisional conflict); (4) patient and clinician satisfaction with the decision made; (5) the rate of major adverse cardiac events at 30 days; (6) the proportion of patients admitted for advanced cardiac testing; and (7) healthcare utilization. To assess these outcomes, we will administer patient and clinician surveys immediately after each clinical encounter, obtain video recordings of the patient-clinician discussion, administer a patient healthcare utilization diary, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up. Discussion: This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in low-risk chest pain patients from a variety of geographically and ethnically diverse EDs. Trial registration: NCT01969240.

Original languageEnglish (US)
Article number166
JournalTrials
Volume15
Issue number1
DOIs
StatePublished - May 10 2014

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Keywords

  • Acute coronary syndrome
  • Acute myocardial infarction
  • Chest pain
  • Emergency department
  • Healthcare utilization
  • Shared decision-making
  • Unstable angina

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Pharmacology (medical)

Cite this

Anderson, R. T., Montori, V. M., Shah, N. D., Ting, H. H., Pencille, L. J., Demers, M., Kline, J. A., Diercks, D. B., Hollander, J. E., Torres, C. A., Schaffer, J. T., Herrin, J., Branda, M., Leblanc, A., & Hess, E. P. (2014). Effectiveness of the chest pain choice decision aid in emergency department patients with low-risk chest pain: Study protocol for a multicenter randomized trial. Trials, 15(1), [166]. https://doi.org/10.1186/1745-6215-15-166