title: Effectiveness of the Chest Pain Choice decision aid in emergency department patients with low-risk chest pain: study protocol for a multicenter randomized trial.
abstract: BACKGROUND
  Chest pain is the second most common reason patients visit emergency departments (EDs) and often results in very low-risk patients being admitted for prolonged observation and advanced cardiac testing. Shared decision-making, including educating patients regarding their 45-day risk for acute coronary syndrome (ACS) and management options, might safely decrease healthcare utilization.
  
  
  METHODS
  This is a protocol for a multicenter practical patient-level randomized trial to compare an intervention group receiving a decision aid, Chest Pain Choice (CPC), to a control group receiving usual care. Adults presenting to five geographically and ethnically diverse EDs who are being considered for admission for observation and advanced cardiac testing will be eligible for enrollment. We will measure the effect of CPC on (1) patient knowledge regarding their 45-day risk for ACS and the available management options (primary outcome); (2) patient engagement in the decision-making process; (3) the degree of conflict patients experience related to feeling uninformed (decisional conflict); (4) patient and clinician satisfaction with the decision made; (5) the rate of major adverse cardiac events at 30 days; (6) the proportion of patients admitted for advanced cardiac testing; and (7) healthcare utilization. To assess these outcomes, we will administer patient and clinician surveys immediately after each clinical encounter, obtain video recordings of the patient-clinician discussion, administer a patient healthcare utilization diary, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up.
  
  
  CONCLUSIONS
  This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in low-risk chest pain patients from a variety of geographically and ethnically diverse EDs.
  
  
  BACKGROUND
  NCT01969240.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Anderson
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Pencille
authors.forename: Michel
authors.initials: M
authors.lastname: Demers
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Torres
authors.forename: Jason T
authors.initials: JT
authors.lastname: Schaffer
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Megan
authors.initials: M
authors.lastname: Branda
authors.forename: Annie
authors.initials: A
authors.lastname: Leblanc
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Hess.Erik@mayo.edu.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Hess
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000209:etiology; D000789:Angina, Unstable / Q000175:diagnosis* / Q000209:etiology; D016507:Cardiology Service, Hospital; D002985:Clinical Protocols; D003142:Communication; D003220:Conflict, Psychological; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D007722:Health Knowledge, Attitudes, Practice; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011237:Predictive Value of Tests; D011379:Prognosis; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014741:Video Recording