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

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...

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Autores principales: Hicks, Kathryn, Cocks, Kim, Corbacho Martin, Belen, Elton, Peter, MacNab, Anita, Colecliffe, Wendy, Furze, Gill
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197216/
https://www.ncbi.nlm.nih.gov/pubmed/25280578
http://dx.doi.org/10.1186/1471-2261-14-138
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author Hicks, Kathryn
Cocks, Kim
Corbacho Martin, Belen
Elton, Peter
MacNab, Anita
Colecliffe, Wendy
Furze, Gill
author_facet Hicks, Kathryn
Cocks, Kim
Corbacho Martin, Belen
Elton, Peter
MacNab, Anita
Colecliffe, Wendy
Furze, Gill
author_sort Hicks, Kathryn
collection PubMed
description 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). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2261-14-138) contains supplementary material, which is available to authorized users.
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spelling pubmed-41972162014-10-16 An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial Hicks, Kathryn Cocks, Kim Corbacho Martin, Belen Elton, Peter MacNab, Anita Colecliffe, Wendy Furze, Gill BMC Cardiovasc Disord Research Article 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). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2261-14-138) contains supplementary material, which is available to authorized users. BioMed Central 2014-10-04 /pmc/articles/PMC4197216/ /pubmed/25280578 http://dx.doi.org/10.1186/1471-2261-14-138 Text en © Hicks et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hicks, Kathryn
Cocks, Kim
Corbacho Martin, Belen
Elton, Peter
MacNab, Anita
Colecliffe, Wendy
Furze, Gill
An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial
title An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial
title_full An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial
title_fullStr An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial
title_full_unstemmed An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial
title_short An intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial
title_sort intervention to reassure patients about test results in rapid access chest pain clinic: a pilot randomised controlled trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197216/
https://www.ncbi.nlm.nih.gov/pubmed/25280578
http://dx.doi.org/10.1186/1471-2261-14-138
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