title: The chest pain choice decision aid: a randomized trial.
abstract: BACKGROUND
  Cardiac stress testing in patients at low risk for acute coronary syndrome is associated with increased false-positive test results, unnecessary downstream procedures, and increased cost. We judged it unlikely that patient preferences were driving the decision to obtain stress testing.
  
  
  RESULTS
  The Chest Pain Choice trial was a prospective randomized evaluation involving 204 patients who were randomized to a decision aid or usual care and were followed for 30 days. The decision aid included a 100-person pictograph depicting the pretest probability of acute coronary syndrome and available management options (observation unit admission and stress testing or 24-72 hours outpatient follow-up). The primary outcome was patient knowledge measured by an immediate postvisit survey. Additional outcomes included patient engagement in decision making and the proportion of patients who decided to undergo observation unit admission and cardiac stress testing. Compared with usual care patients (n=103), decision aid patients (n=101) had significantly greater knowledge (3.6 versus 3.0 questions correct; mean difference, 0.67; 95% CI, 0.34-1.0), were more engaged in decision making as indicated by higher OPTION (observing patient involvement) scores (26.6 versus 7.0; mean difference, 19.6; 95% CI, 1.6-21.6), and decided less frequently to be admitted to the observation unit for stress testing (58% versus 77%; absolute difference, 19%; 95% CI, 6%-31%). There were no major adverse cardiac events after discharge in either group.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Division of Emergency Medicine Research, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA. hess.erik@mayo.edu
authors.forename: Erik P
authors.initials: EP
authors.lastname: Hess
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Knoedler
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
authors.forename: Maggie
authors.initials: M
authors.lastname: Breslin
authors.forename: Megan E
authors.initials: ME
authors.lastname: Branda
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Pencille
authors.forename: Brent R
authors.initials: BR
authors.lastname: Asplin
authors.forename: David M
authors.initials: DM
authors.lastname: Nestler
authors.forename: Annie T
authors.initials: AT
authors.lastname: Sadosty
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000787:Angina Pectoris / Q000209:etiology* / Q000628:therapy; D003220:Conflict, Psychological; D003661:Decision Support Techniques; D003935:Diagnostic Techniques, Cardiovascular; D004636:Emergency Service, Hospital; D005080:Exercise Test; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010358:Patient Participation; D057240:Patient Preference; D017060:Patient Satisfaction; D018579:Patient Selection; D010817:Physician-Patient Relations; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D035502:Trust; D019564:Unnecessary Procedures