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An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial.

Hicks K, Cocks K, Corbacho Martin B, Elton P, MacNab A, Colecliffe W, Furze G - BMC Cardiovasc Disord (2014)

Bottom Line: Consequently, many patients are not reassured they have the correct diagnosis or treatment.There was no evidence of a difference between the Discussion and Pamphlet arms in the mean reassurance score at month 1 (34.2 vs 33.7) or at month 6 (35.3 vs 35.9).Patient-reported chest pain and use of heart medications were also similar between the two arms.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, York Trials Unit, University of York, York YO10 5DD, UK. kate.hicks@york.ac.uk.

ABSTRACT

Background: Most people referred to rapid access chest pain clinics have non-cardiac chest pain, and in those diagnosed with stable coronary heart disease, guidance recommends that first-line treatment is usually medication rather than revascularisation. Consequently, many patients are not reassured they have the correct diagnosis or treatment. A previous trial reported that, in people with non-cardiac chest pain, a brief discussion with a health psychologist before the tests about the meaning of potential results led to people being significantly more reassured. The aim of this pilot was to test study procedures and inform sample size for a future multi-centre trial and to gain initial estimates of effectiveness of the discussion intervention.

Methods: This was a two-arm pilot randomised controlled trial in outpatient rapid access chest pain clinic in 120 people undergoing investigation for new onset, non-urgent chest pain. Eligible participants were randomised to receive either: a discussion about the meaning and implication of test results, delivered by a nurse before tests in clinic, plus a pre-test pamphlet covering the same information (Discussion arm) or the pre-test pamphlet alone (Pamphlet arm). Main outcome measures were recruitment rate and feasibility for a future multi-centre trial, with an estimate of reassurance in the groups at month 1 and 6 using a 5-item patient-reported scale.

Results: Two hundred and seventy people attended rapid access chest pain clinic during recruitment and 120/270 participants (44%) were randomised, 60 to each arm. There was no evidence of a difference between the Discussion and Pamphlet arms in the mean reassurance score at month 1 (34.2 vs 33.7) or at month 6 (35.3 vs 35.9). Patient-reported chest pain and use of heart medications were also similar between the two arms.

Conclusions: A larger trial of the discussion intervention in the UK would not be warranted. Patients reported high levels of reassurance which were similar in patients receiving the discussion with a nurse and in those receiving a pamphlet alone.

Trial registration: Current Controlled Trials ISRCTN60618114 (assigned 27.05.2011).

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Related in: MedlinePlus

Flow of participants through the study.
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Fig1: Flow of participants through the study.

Mentions: 120 patients (60/arm) were recruited in 8 months (Oct 2011 to May 2012). Figure 1 shows the flow of participants through the study and Table 2 summarises their baseline characteristics. Around 40% of patients attending RACPC were randomised in the study. All participants received their allocated intervention: the pre-test pamphlet plus a discussion with a nurse (Discussion arm) or the pre-test pamphlet alone (Pamphlet arm). Patients had a mean age of 54 (SD 12) and just under half were male. Sixty-two (52%) patients were taking heart-related medications at baseline, the majority of which were from one or more of the following classes: beta blockers, statins, anti-platelets, glyceryl trinitrate, other anti-anginals.Figure 1


An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial.

Hicks K, Cocks K, Corbacho Martin B, Elton P, MacNab A, Colecliffe W, Furze G - BMC Cardiovasc Disord (2014)

Flow of participants through the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197216&req=5

Fig1: Flow of participants through the study.
Mentions: 120 patients (60/arm) were recruited in 8 months (Oct 2011 to May 2012). Figure 1 shows the flow of participants through the study and Table 2 summarises their baseline characteristics. Around 40% of patients attending RACPC were randomised in the study. All participants received their allocated intervention: the pre-test pamphlet plus a discussion with a nurse (Discussion arm) or the pre-test pamphlet alone (Pamphlet arm). Patients had a mean age of 54 (SD 12) and just under half were male. Sixty-two (52%) patients were taking heart-related medications at baseline, the majority of which were from one or more of the following classes: beta blockers, statins, anti-platelets, glyceryl trinitrate, other anti-anginals.Figure 1

Bottom Line: Consequently, many patients are not reassured they have the correct diagnosis or treatment.There was no evidence of a difference between the Discussion and Pamphlet arms in the mean reassurance score at month 1 (34.2 vs 33.7) or at month 6 (35.3 vs 35.9).Patient-reported chest pain and use of heart medications were also similar between the two arms.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, York Trials Unit, University of York, York YO10 5DD, UK. kate.hicks@york.ac.uk.

ABSTRACT

Background: Most people referred to rapid access chest pain clinics have non-cardiac chest pain, and in those diagnosed with stable coronary heart disease, guidance recommends that first-line treatment is usually medication rather than revascularisation. Consequently, many patients are not reassured they have the correct diagnosis or treatment. A previous trial reported that, in people with non-cardiac chest pain, a brief discussion with a health psychologist before the tests about the meaning of potential results led to people being significantly more reassured. The aim of this pilot was to test study procedures and inform sample size for a future multi-centre trial and to gain initial estimates of effectiveness of the discussion intervention.

Methods: This was a two-arm pilot randomised controlled trial in outpatient rapid access chest pain clinic in 120 people undergoing investigation for new onset, non-urgent chest pain. Eligible participants were randomised to receive either: a discussion about the meaning and implication of test results, delivered by a nurse before tests in clinic, plus a pre-test pamphlet covering the same information (Discussion arm) or the pre-test pamphlet alone (Pamphlet arm). Main outcome measures were recruitment rate and feasibility for a future multi-centre trial, with an estimate of reassurance in the groups at month 1 and 6 using a 5-item patient-reported scale.

Results: Two hundred and seventy people attended rapid access chest pain clinic during recruitment and 120/270 participants (44%) were randomised, 60 to each arm. There was no evidence of a difference between the Discussion and Pamphlet arms in the mean reassurance score at month 1 (34.2 vs 33.7) or at month 6 (35.3 vs 35.9). Patient-reported chest pain and use of heart medications were also similar between the two arms.

Conclusions: A larger trial of the discussion intervention in the UK would not be warranted. Patients reported high levels of reassurance which were similar in patients receiving the discussion with a nurse and in those receiving a pamphlet alone.

Trial registration: Current Controlled Trials ISRCTN60618114 (assigned 27.05.2011).

Show MeSH
Related in: MedlinePlus