A shared decision making tool called Chest Pain Choice allows patients in an emergency department to engage with physicians to improve their knowledge of their health status and follow-up care options, according to research presented at the 2016 American College of Cardiology Annual Scientific Sessions & Expo.

Erik P. Hess, MD, MSc, research chair for the Department of Emergency Medicine and associate director for the Healthcare Delivery Research Scholars Program at Mayo Clinic, and colleagues conducted a study to determine the effectiveness of Chest Pain Choice on patient knowledge in 6 emergency departments across the United States.

Chest pain is a common patient complaint that accounts for approximately 20% of hospital admissions each year in the United States. Dr Hess explained that patients in an emergency department presenting with low-risk chest pain often assume the worst. “They often feel like they’re going to die of a heart attack,” Dr Hess noted during his presentation. “It’s an emotionally charged situation.”


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The Chest Pain Choice tool is a 1-page information sheet that provides information regarding a patient’s specific risk profile. It was designed to help patients understand their objective level of risk, which subsequently decreases anxiety. The tool comprises of 4 sections including the doctor’s diagnosis, information regarding additional testing, the patient’s personal risk for acute coronary syndrome within a 45 day period, and any additional options for follow-up care.

Dr Hess added that the tool does not recommend a decision for care, but instead provides a comprehensive list of options to make them more transparent.

“From a human rights perspective, patients have made it clear that one way they interpret the idea of ‘care with dignity’ is being involved in their health care decisions,” said Dr Hess said in a press release. “This trial shows that doing so can have a beneficial effect on patient knowledge, as well as other outcomes such as patient engagement and, sometimes, appropriate utilization of testing. I would recommend that this intervention be adopted more widely.”

Researchers randomly assigned patients to participate either in a physician discussion with Chest Pain Choice (n=447) or a standard physician consultation (n=451) between October 2013 and August 2015. The participants also answered questions on a questionnaire regarding their personal risk and follow-up options.

The patients who used Chest Pain Choice answered 53% of the questions correctly, compared with 44.6% of patients from the control group. An objective analysis of patient-physician interactions found that patients who used Chest Pain Choice were twice as engaged in the decision-making process.

When the participants were asked about their experience discussing follow-up care with a physician, 68.9% of the patients who used Chest Pain Choice stated that they would recommend the method of the consultation, while 43.6% felt conflicted. In the control group, 61.2% of patients would recommend the method of consultation, while 46.4% felt conflicted.

Dr Hess noted that stress testing is frequently obtained in low-risk patients. However, only 37.4% of patients who used Chest Pain Choice received a stress test, compared with 46.3% in the control group.

Reference

Hess EP. ACC/JAMA LBCT. Involving patients with low risk chest pain in discharge decisions: a multicenter trial. Presented at the 65th Annual Scientific Session and Expo of the American College of Cardiology. April 2-4, 2016; Chicago, IL.