Decision Aid for Chest Pain in ER Engages Patients

Patient-centered decision making improves patient knowledge, decreases admissions for observation

TUESDAY, April 10 (HealthDay News) -- Use of a decision aid, a visual patient education tool, helps chest pain patients become more engaged in their care and results in fewer admissions for observation and stress testing, without negatively impacting care outcomes, according to a study published online April 10 in Circulation: Cardiovascular Quality and Outcomes.

Erik P. Hess, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues evaluated data from 204 patients participating in the Chest Pain Choice trial. Patients were randomized to a decision aid or usual care. The decision aid included a 100-person pictograph showing the pretest probability of acute coronary syndrome as well as options for available management. A post-visit survey measured patient knowledge. Patients were followed for 30 days.

The researchers found that, compared with the usual care patients, decision aid patients had significantly greater knowledge (3.6 versus 3.0 survey questions correct; mean difference, 0.67), were more engaged in decision making as indicated by higher observed patient involvement scores (26.6 versus 7.0; mean difference, 19.6), and less frequently chose to be admitted to the observation unit for stress testing (58 versus 77 percent; absolute difference, 19 percent). Neither group had major adverse cardiac events after discharge.

"Use of a decision aid in patients with chest pain increased knowledge and engagement in decision making and decreased the rate of observation unit admission for stress testing," the authors conclude.

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