Using a decision aid for chest pain increased patient knowledge and engagement and decreased admissions for stress tests

A newly published research study has found that patients randomized to the Chest Pain Choice decision aid had significantly greater knowledge, were more engaged in the decision-making process, and decided less frequently to be admitted to the observation unit for cardiac stress testing. 

The research, published in Circulation: Cardiovascular Quality and Outcomes, involved 204 patients who were randomized to a decision aid or usual care and were followed for 30 days. 

The research found the patients randomized to the shared decision-making arm answered a greater number of questions in the knowledge questionnaire correctly. They also had greater knowledge regarding their exact pretest probability of ACS within 45 days.  Patients who used the decision aid also experienced less decisional conflict when engaging in management decisions regarding their care.  Use of the decision aid did not alter patients' trust in their healthcare propfessionals.

Analysis of the video-recorded visits (100 decision aid visits and 100 usual care visits) revealed that patient involvement in clinical decision making was significantly greater in the shared decision-making arm than in the usual care arm as judged by the OPTION scale.  Patients who used the decision aid reported greater satisfaction with the decision-making process.

The decision aid was acceptable, clear, and helpful to patients and clinicians. Of the 51 clinicians who used the decision aid, 50 (98%) considered it helpful, and 32 (63%) indicated their desire to use the decision aid again if given the opportunity.  Most clinicians indicated a desire to use a decision aid for other clinical management decisions.

A lower proportion of patients who used the decision aid decided to be admitted to the observation unit for stress testing (58% versus 77%).  There were no major adverse cardiac events after discharge in either group.

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