Patient Perspectives

Bon Secours Memorial College of Nursing

NUR 3241: Quality Safety and Nursing Practice

Jamie Driggs, RN

June 26, 2021

“I pledge…”
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Patient Perspectives

The study I have chosen for the patient perspectives assignment is a randomized

controlled trial titled: “Testing a Decision Aid for Patients with Low-Risk Chest Pain in the

Emergency Room -- The Chest Pain Choice Trial” conducted by Erik P. Hess, Judd E.

Hollander, Jason T. Schaffer, Jeffrey A. Kline, Carlos A. Torres, Deborah B. Diercks, Russell

Jones, Kelly P. Owen, Zachary F. Meisel, Michel Demers, Annie Leblanc, Nilay D. Shah,

Jonathan Inselman, Jeph Herrin, Ana Castaneda-Guarderas, and Victor M. Montori. The study

investigated the effects of utilizing a decision aid for patients reporting to the emergency room

with complaints of chest pain who were at low risk for acute coronary syndrome (ACS) and not

diagnosed with a heart attack.

As a cardiac nurse, I am always interested in how patients come to having stress testing

performed. I also believe this study shows strong evidence that may reduce the number and costs

associated with unnecessary testing that we perform on patients with atypical chest pain. I chose

this study with the hopes that I may be able to bring evidence-based practice updates to discuss

within my clinical area.

Reflection as the Clinician

From the perspective of an emergency room physician, I would want to perform all the

tests available to accurately determine the cause of my patient's chest pain, even though I am

aware this can be cumbersome for the patient to experience and the cost for in-depth testing

without prior insurance authorization could be detrimental to some. As I am not a specialist in

cardiology, I would feel uncomfortable about not pursuing further evaluation. Would I be

causing my patient harm if I did not recommend further testing? Would I be putting my patient at

risk for a serious adverse event if I discharge them home with a referral to a cardiologist? Or
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would I be overusing available resources and creating unnecessary costs for my patient to tackle

while trying to manage their health condition? These are very heavy decisions for a clinician to

make on behalf of someone else.

The purpose of the chosen research study topic for the clinician is to create a process that

will enhance patient knowledge of their personal cardiovascular risk, foster shared decision

making between the patient and the clinician, and reduce unnecessary hospital admissions and

costly testing while not putting the patient at greater risk for an adverse event. This research

study demonstrated positive reductions in hospital admissions and stress testing for patients

presenting with chest pain, without increasing the patient’s risk of experiencing an adverse event

by presenting the patient with a personalized cardiovascular risk assessment and increasing their

knowledge of available services and options for their next steps (Hess et al., 2013)

Another research study that supports these findings is “Implementation of a health-

literate patient decision aid for chest pain in the emergency department” (Hadden et al., 2020).

Findings from this study were similar, in that hospital admission rates for patients presenting

with chest pain were 2.6 times higher in the group that did not receive intervention with the

shared decision-making aid, and patient knowledge was increased with the use of a decision aid

(Hadden et al., 2020).

Patient-Centered Research

Patient-centeredness in research means that the patient is the primary cause for why the

research is being done; to improve patients overall health and quality of life, through

improvement and innovation. As a nurse, my mission is to provide safe and skilled care to those

who need it, which would not be possible without evidence-based research that holds the

patient’s needs and well-being at its core. To focus only on a disease process without
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incorporating the patient's experience of and ability to manage it would likely lead to non-

compliance and increased complications.

On my very first day of nursing school, at the beginning of the lecture our professor

provided each student with a bedpan. Our first assignment was to see how long we could sit on

the bedpan during the lecture. This was my first introduction to the patient perspective, and I will

never forget how quickly I became uncomfortable from physical pain. Because of this simple

lesson, I always practice empathy and consider how I would feel in my patient's unique situation.

It has been well over 10 years since that lecture, and it is a memory that will stay with me

forever.
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References

Hadden, K. B., McLemore, H., White, W., Marks, M. H., Gan, J. M., & Seupaul, R. A. (2020).

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

department. Patient Education and Counseling, 103(4), 864–869.

https://doi.org/10.1016/j.pec.2019.11.009

Hess, E. P., Hollander, J. E., Schaffer, J. T., Kline, J. A., Torres, C. A., Diercks, D. N., Jones, R.,

Owen, K. P., Meisel, Z. F., Demers, M., Leblanc, A., Shah, N. D., Inselman, J., Herrin, J.,

Castaneda-Guarderas, A., & Montori, V. M. (2013). Testing a decision aid for patients

with low-risk chest pain in the emergency room - The chest pain choice trial. Patient-

Centered Outcomes Research Institute (PCORI).

http://doi.org/10.25302/3.2018.CER.952