The Chest Pain Choice trial: A pilot randomized trial of a decision aid for patients with chest pain in the emergency department

Meghan A. Pierce, Erik P. Hess, Jeffrey Kline, Nilay D. Shah, Maggie Breslin, Megan E. Branda, Laurie J. Pencille, Brent R. Asplin, David M. Nestler, Annie T. Sadosty, Ian G. Stiell, Henry H. Ting, Victor M. Montori

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Chest 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/Design: This 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.Discussion: This 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 registration: Clinical Trials.gov Identifier: NCT01077037.

Original languageEnglish (US)
Article number57
JournalTrials
Volume11
DOIs
StatePublished - May 17 2010
Externally publishedYes

Fingerprint

Decision Support Techniques
Chest Pain
Hospital Emergency Service
Acute Coronary Syndrome
Patient Participation
Decision Making
Observation
Video Recording
Information Dissemination
Hospital Departments
Emergency Medical Services
Health Care Costs
Economics
Clinical Trials
Control Groups

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Pharmacology (medical)

Cite this

The Chest Pain Choice trial : A pilot randomized trial of a decision aid for patients with chest pain in the emergency department. / Pierce, Meghan A.; Hess, Erik P.; Kline, Jeffrey; Shah, Nilay D.; Breslin, Maggie; Branda, Megan E.; Pencille, Laurie J.; Asplin, Brent R.; Nestler, David M.; Sadosty, Annie T.; Stiell, Ian G.; Ting, Henry H.; Montori, Victor M.

In: Trials, Vol. 11, 57, 17.05.2010.

Research output: Contribution to journalArticle

Pierce, MA, Hess, EP, Kline, J, Shah, ND, Breslin, M, Branda, ME, Pencille, LJ, Asplin, BR, Nestler, DM, Sadosty, AT, Stiell, IG, Ting, HH & Montori, VM 2010, 'The Chest Pain Choice trial: A pilot randomized trial of a decision aid for patients with chest pain in the emergency department', Trials, vol. 11, 57. https://doi.org/10.1186/1745-6215-11-57
Pierce, Meghan A. ; Hess, Erik P. ; Kline, Jeffrey ; Shah, Nilay D. ; Breslin, Maggie ; Branda, Megan E. ; Pencille, Laurie J. ; Asplin, Brent R. ; Nestler, David M. ; Sadosty, Annie T. ; Stiell, Ian G. ; Ting, Henry H. ; Montori, Victor M. / The Chest Pain Choice trial : A pilot randomized trial of a decision aid for patients with chest pain in the emergency department. In: Trials. 2010 ; Vol. 11.
@article{b902e4d817214f17b53d84e65bbd8587,
title = "The Chest Pain Choice trial: A pilot randomized trial of a decision aid for patients with chest pain in the emergency department",
abstract = "Background: Chest 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/Design: This 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.Discussion: This 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 registration: Clinical Trials.gov Identifier: NCT01077037.",
author = "Pierce, {Meghan A.} and Hess, {Erik P.} and Jeffrey Kline and Shah, {Nilay D.} and Maggie Breslin and Branda, {Megan E.} and Pencille, {Laurie J.} and Asplin, {Brent R.} and Nestler, {David M.} and Sadosty, {Annie T.} and Stiell, {Ian G.} and Ting, {Henry H.} and Montori, {Victor M.}",
year = "2010",
month = "5",
day = "17",
doi = "10.1186/1745-6215-11-57",
language = "English (US)",
volume = "11",
journal = "Trials",
issn = "1745-6215",
publisher = "BioMed Central",

}

TY - JOUR

T1 - The Chest Pain Choice trial

T2 - A pilot randomized trial of a decision aid for patients with chest pain in the emergency department

AU - Pierce, Meghan A.

AU - Hess, Erik P.

AU - Kline, Jeffrey

AU - Shah, Nilay D.

AU - Breslin, Maggie

AU - Branda, Megan E.

AU - Pencille, Laurie J.

AU - Asplin, Brent R.

AU - Nestler, David M.

AU - Sadosty, Annie T.

AU - Stiell, Ian G.

AU - Ting, Henry H.

AU - Montori, Victor M.

PY - 2010/5/17

Y1 - 2010/5/17

N2 - Background: Chest 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/Design: This 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.Discussion: This 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 registration: Clinical Trials.gov Identifier: NCT01077037.

AB - Background: Chest 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/Design: This 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.Discussion: This 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 registration: Clinical Trials.gov Identifier: NCT01077037.

UR - http://www.scopus.com/inward/record.url?scp=77953887833&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953887833&partnerID=8YFLogxK

U2 - 10.1186/1745-6215-11-57

DO - 10.1186/1745-6215-11-57

M3 - Article

C2 - 20478056

AN - SCOPUS:77953887833

VL - 11

JO - Trials

JF - Trials

SN - 1745-6215

M1 - 57

ER -