Effectiveness of a Decision Aid in Potentially Vulnerable Patients: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial

Medical Decision Making : an International Journal of the Society for Medical Decision Making
Kristin L RisingErik Hess

Abstract

We test the hypotheses that use of the Chest Pain Choice (CPC) decision aid (DA) would be similarly effective in potentially vulnerable subgroups but increase knowledge more in patients with higher education and trust in physicians more in patients from racial minority groups. This was a secondary analysis of a multicenter randomized trial in adults with chest pain potentially due to acute coronary syndrome. The trial compared an intervention group engaged in shared decision making (SDM) using CPC to a control group receiving usual care (UC). We assessed for subgroup effects based on age, sex, race, income, insurance, education, literacy, and numeracy. We dichotomized each characteristic and tested for interactions using regression models with indicators for arm assignment and study site. Of 898 patients (451 DA, 447 UC), over 50% were female, over one-third were black, nearly one-third had a high school education or less, and over 60% had "low" health literacy. The DA did not increase knowledge more in patients with higher education ( P for interaction = 0.06) but did increase knowledge more in the "typical" than in the "low" numeracy subgroup (10.6% v. 4.7%, absolute difference [AD] = 5.9%, P for interaction = 0.025). The DA ...Continue Reading

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Citations

Nov 24, 2019·Health Expectations : an International Journal of Public Participation in Health Care and Health Policy·Rachel M SkainsErik P Hess
Jun 27, 2019·Journal of Women's Health·Marilyn M SchapiraJoan M Neuner
Jun 22, 2021·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Renata W YenMarie-Anne Durand
Jun 1, 2021·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Danielle M MuscatKirsten McCaffery

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Methods Mentioned

BETA
coronary artery bypass

Software Mentioned

Stata

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