- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02971163
Syncope Decision Aid for Emergency Care (SynDA)
SynDA: Syncope Decision Aid for Emergency Care
Syncope, or transient loss of consciousness/fainting, is a common emergency department (ED) complaint responsible for over 1 million ED visits yearly. Potential causes include benign conditions such as dehydration or vaso-vagal syncope. Rarely, syncope is the result of serious cardiac conditions. In older patients without a clear cause of syncope hospital admission is frequently initiated at very low risk thresholds, though there is little evidence that these admissions improve patient outcomes. These decisions are often made without significant patient input or discussion of reasonable alternatives. In this situation, a patient's values, preferences, and particular circumstances should be taken into account. This mutualistic approach to clinical management is referred to as Shared Decision-Making. Shared Decision-Making (SDM) is a joint process of choice selection between providers and patients in clinical scenarios where multiple reasonable management options exist. To improve syncope emergency care, the researchers can leverage recent advances in risk stratification to engage patients in SDM and deliver superior, patient-centered care.
This study will provide the groundwork for a larger, randomized controlled trial evaluating the effects of the decision aid for management of low-risk syncope.
Study Overview
Detailed Description
Setting:
Mount Sinai Hospital (MSH) has a 61-bed adult Emergency Department with a volume of over 100,000 patient visits/year or approximately 300 visits/day. MSH is a large academic tertiary care medical center located in East Harlem and serves a large black and Hispanic community.
Projected Recruitment: There are approximately 60 MSH ED visits for syncope per month of which 35 per month are by patients above age 30. Roughly half of these do not have a clear etiology of their syncope discovered in the ED. The researchers project that of the 17 potentially eligible patients per month, three will be successfully enrolled for a projected 72 patient enrollees at the completion of the 24-month recruitment period. The PI, clinical research coordinators, and SRAs will monitor the real-time electronic tracking system for all ED patients and will identify any patient over age 30 with a chief complaint of syncope or loss of consciousness.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
New York
-
New York, New York, United States, 10029
- Icahn School of Medicine at Mount Sinai
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Emergency Department patient
- Age 30 years or above
- Chief complaint of syncope
- Capacity to make medical decisions
- Speak and read English
- Working phone number and fixed address
Exclusion Criteria:
- Altered Mental Status
- Cognitive Impairment
Serious acute diagnosis:
(e.g. clinically significant cardiac dysrhythmia, structural heart disease, gastrointestinal hemorrhage, myocardial infarction, pulmonary embolism, pneumonia, arterial dissection, serious infection, ectopic pregnancy, subarachnoid hemorrhage, or stroke.)
- Hemodynamic instability
- Inability to read or speak English
- Major communication barrier
- Lack of phone number or fixed address
- Too high risk as per physician judgment
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: SynDA
The research coordinator will print the appropriate version of the SynDA based on the patient's individualized risk score and the corresponding estimated probability of a serious medical event within 30 days.
|
SynDA is a paper-based, personalized decision aid which gives information to patients about their medical condition (i.e.
syncope), future risk, and options for care.
It is written in lay language and aims to create an informed conversation between a patient and their ED provider.
Other Names:
|
No Intervention: Control
Patients in the control arm will receive usual emergency care pertaining to syncope.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants at End of Study
Time Frame: Two years
|
Feasibility of the study will be measured by the number of participants successfully enrolled at the end of the study period.
|
Two years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Knowledge
Time Frame: Within 2 hours post ED disposition on Day 1
|
One brief post-encounter survey will be given to the patient to assess their knowledge surrounding syncope and their satisfaction with their care during the ED visit.
Scores full range is 0-9, higher score indicates more knowledge
|
Within 2 hours post ED disposition on Day 1
|
Decisional Conflict Scale
Time Frame: Within 2 hours post ED disposition on Day 1
|
Decisional quality will be measured by administering the Decisional Conflict Scale to all patients after disposition decision has been made.
The decisional conflict scale total score range from 0 (no decisional conflict) to 10 (extremely high decisional conflict).
|
Within 2 hours post ED disposition on Day 1
|
Utilization Outcomes
Time Frame: Day 1 and 30 day follow up period
|
Number of patients admitted to the hospital or sent to observation unit at index visit and number of patients admitted to the hospital, or had an office visit or during 30-day follow-up period
|
Day 1 and 30 day follow up period
|
Number of Participants With Repeat Visits to the ED
Time Frame: 30-day follow-up period
|
Number of participants with repeat visits to the ED during 30-day follow-up period
|
30-day follow-up period
|
Participants With New Significant Clinical Diagnosis
Time Frame: at 30 days
|
Number of participants with clinical diagnosis at 30 days after index visit to the ED
|
at 30 days
|
Number of Diagnostic Testing
Time Frame: Day 1
|
Number of diagnostic test (which may include but not limited to exercise stress testing, echocardiography, computed tomography scans) performed
|
Day 1
|
OPTION-5 Scale
Time Frame: up to 2 years
|
The degree of patient involvement in the disposition decision as measured by the OPTION (observing patient involvement in decision making) scale.
The OPTION-5 scale is a brief, 5-item instrument used by a trained observer to measure the degree of patient involvement in clinical decision-making and has demonstrated validity and reliability.
Full scores range from 0 to 100, with higher scores indicating higher levels of patient involvement.
|
up to 2 years
|
Collaborators and Investigators
Collaborators
Investigators
- Study Director: Lynne Richardson, MD, Icahn School of Medicine at Mount Sinai
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- GCO 15-1016
- 1K23HL132052-01 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Syncope
-
David B. De LurgioBiosense Webster, Inc.CompletedNeurocardiogenic Syncope | Vasovagal SyncopeUnited States
-
Gruppo Italiano Multidisciplinare per lo Studio...Completed
-
University of CalgaryNot yet recruitingSyncope | Vasovagal Syncope (VVS)Canada
-
Centre of Postgraduate Medical EducationRecruiting
-
University of CalgaryRecruiting
-
Dr. Bob SheldonVanderbilt UniversityActive, not recruitingVasovagal SyncopeUnited States, Canada, Poland
-
University of CalgaryCardiac Arrhythmia Network of CanadaCompleted
-
Gruppo Italiano Multidisciplinare per lo Studio...Completed
-
University of CalgaryCanadian Institutes of Health Research (CIHR)CompletedSyncope, Vasovagal, Neurally-MediatedUnited States, Canada