Use of Visual Decision Aid for Shared Decision Making in Chest Pain

April 12, 2022 updated by: National University Hospital, Singapore

The Use of a Visual Decision Aid for Shared Decision Making Among Patients With Chest Pain

This study aims to evaluate the use of the chest pain choice (CPC) decision aid as a tool to facilitate discussion between the patient and his/her attending physician with regard to subsequent management plans. Patients aged 21 years and above with low-risk chest pain, as determined by the HEART score (HEART score 0-3), will be included. The investigator's hypothesis is that incorporating the Chest Pain Choice visual aid in shared decision making can help to reduce unnecessary admissions for low risk chest pain to the observation ward, as well as increase patient knowledge with regards to their own condition.

Study Overview

Detailed Description

Chest pain is a common presenting complaint in the Emergency Department (ED). Cardiac testing in low-risk patients poses unnecessary costs and resource utilisation, which may in part be due to clinicians adopting a very-low-risk threshold for discharge without testing.

The Chest Pain Choice (CPC) decision aid is a visual aid that was developed to facilitate shared decision-making between physicians and patients who present to the emergency department with chest pain, and has shown to be effective in increasing patient knowledge and decreasing the rate of admission to an observation unit for cardiac testing, among patients with chest pain who are at low risk for acute coronary syndromes. Shared decision making with the use of this visual aid has been shown in other centres to be associated with greater patient knowledge, greater patient involvement in decision making and less frequent admissions, with no increase in major adverse cardiac events (MACE) due to the intervention.

The visual aid includes a brief description of what tests have been done thus far to assess the patient's risk of MACE, a graphic representation of the risk as calculated based on the HEART score, as well as the evaluation options available. The visual aid has been modified from its original form for the local context in terms of viable options for further evaluation.

This study aims to assess if using a visual decision aid for shared decision making between physician and patient can safely help to decrease unnecessary admissions to the ED observation unit, as well as its impact on patient knowledge, satisfaction, as well as 30-day and 60-day Major Adverse Cardiac Events (MACE).

Study Type

Interventional

Enrollment (Actual)

18

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Central
      • Singapore, Central, Singapore, 119074
        • Mui Teng Chua

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years to 99 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Aged 21 years and above
  • Have low risk chest pain as defined by the HEART score (0-3 points)
  • Be English-literate
  • Have an initial serum troponin that is less than the 99th centile of the normal reference population
  • Have an initial electrocardiogram that is not suggestive of cardiac ischaemia

Exclusion Criteria:

  • Have a HEART score of 4 or more
  • Are not English-literate
  • Have an elevated initial serum troponin
  • Have an initial electrocardiogram that is suggestive of cardiac ischaemia (ST-segment depression or elevation, new onset left bundle brunch block, T-wave inversions, etc.)
  • Have known coronary artery disease
  • Have a prior plan for cardiac intervention or admission
  • Have barriers to outpatient follow-up
  • Are prisoners
  • Are pregnant
  • Are hearing or visually impaired, or are otherwise unable to use the clinical decision aid
  • Do not consent to participation in the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention Arm
Patients in the intervention arm will receive the Chest Pain Choice visual aid prior to discussion with their primary physician regarding disposition.
The Chest Pain Choice (CPC) decision aid is a visual aid that was developed to facilitate shared decision-making between physicians and patients who present to the emergency department with chest pain. The visual aid includes a brief description of what tests have been done thus far to assess the patient's risk of MACE, a graphic representation of the risk as calculated based on the HEART score, as well as the evaluation options available. The visual aid has been modified from its original form for the local context in terms of viable options for further evaluation.
No Intervention: Control Arm
Patients in the control arm will not receive the Chest Pain Choice visual aid and will receive standard care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Admission to the Emergency Department Observation Unit
Time Frame: Index visit
Admission to the Emergency Department Observation Unit during index emergency department visit
Index visit

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Major Adverse Cardiac Events (MACE) at 30 days
Time Frame: 30 days after index visit
MACE is defined as all-cause mortality, myocardial infarction or coronary revascularisation.
30 days after index visit
Major Adverse Cardiac Events at 60 days
Time Frame: 60 days after index visit
MACE is defined as all-cause mortality, myocardial infarction or coronary revascularisation.
60 days after index visit
Emergency Department Attendance at 30 days
Time Frame: 30 days after index visit
Repeat attendance to the emergency department
30 days after index visit
Emergency Department Attendance at 60 days
Time Frame: 60 days after index visit
Repeat attendance to the emergency department
60 days after index visit
Stress treadmill electrogram at 30 days
Time Frame: 30 days after index visit
The presence of stress treadmill electrocardiogram at 30 days post index visit
30 days after index visit
Stress treadmill electrogram at 60 days
Time Frame: 60 days after index visit
The presence of stress treadmill electrocardiogram at 60 days post index visit
60 days after index visit
Stress myocardial perfusion imaging at 30 days
Time Frame: 30 days after index visit
The presence of stress myocardial perfusion imaging at 30 days post index visit
30 days after index visit
Stress myocardial perfusion imaging at 60 days
Time Frame: 60 days after index visit
The presence of stress myocardial perfusion imaging at 60 days post index visit
60 days after index visit
Stress echocardiogram at 30 days
Time Frame: 30 days after index visit
The presence of stress echocardiogram at 30 days post index visit
30 days after index visit
Stress echocardiogram at 60 days
Time Frame: 60 days after index visit
The presence of stress echocardiogram at 60 days post index visit
60 days after index visit
Computed tomography of the coronary arteries (CTCA) at 30 days
Time Frame: 30 days after index visit
The presence of computed tomography of the coronary arteries (CTCA) at 30 days post index visit
30 days after index visit
Computed tomography of the coronary arteries (CTCA) at 60 days
Time Frame: 60 days after index visit
The presence of computed tomography of the coronary arteries (CTCA) at 60 days post index visit
60 days after index visit

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2019

Primary Completion (Actual)

September 3, 2021

Study Completion (Actual)

September 3, 2021

Study Registration Dates

First Submitted

August 26, 2018

First Submitted That Met QC Criteria

September 14, 2018

First Posted (Actual)

September 17, 2018

Study Record Updates

Last Update Posted (Actual)

April 20, 2022

Last Update Submitted That Met QC Criteria

April 12, 2022

Last Verified

August 1, 2021

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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.

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