Implementation of a health-literate patient decision aid for chest pain in the emergency department

• Published in: Patient education and counseling 2020-04, Vol.103 (4), p.864-869
• Main Authors: Hadden, Kristie B., McLemore, Heather, White, Wesley, Marks, Matthew H., Gan, Jennifer M., Seupaul, Rawle A.
• Format: Article
• Language: English
• Subjects: Chest pain; Chest Pain - diagnosis; Chest Pain - therapy; Decision aid; Decision Support Techniques; Emergency department; Emergency Service, Hospital; Health Literacy; Hospitalization; Humans; Nursing
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2019.11.009

•Patients receiving decision aid were far less likely to be admitted for chest pain.•Health-literacy based shared decision tool increased patient chest pain knowledge.•Health-literacy based shared decision tool can reduce barriers to understanding. The aim of this study was to investigate the implementation of a new health-literacy-tested patient decision aid for chest pain in Emergency Department (ED) patients. Outcomes included disposition, knowledge, decisional conflict and satisfaction prior to discharge. Patient health literacy was explored as a factor that may explain disparities in sub-group analysis of all outcomes. A health-literacy adapted tool was deployed using a pre/post intervention design. Patients enrolled during the intervention period were given the adapted chest pain decision aid that was used in conversation with their emergency medicine physician to decide on their course of action prior to being discharged. A total of 169 participants were surveyed and used in the final analysis. Patients in the usual care group were 2.6 times more likely to be admitted for chest pain than patients in the intervention group. Knowledge scores were higher in the intervention group, while no significant differences were observed in decisional conflict and patient satisfaction, or by patient health literacy level. Using the adapted chest pain decision tool in emergency medicine may improve knowledge and reduce admissions, while addressing known barriers to understanding related to patient health literacy.