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Published on: January 15, 2017
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Shared Decision Making for Syncope in the Emergency Department: A Randomized Controlled Feasibility Trial
Marc A Probst1, Michelle P Lin1, Jeremy J Sze1
1From the, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Summary
A randomized controlled trial of a shared decision-making (SDM) tool for syncope patients in the emergency department (ED) is feasible. The study demonstrated increased patient involvement with the SDM tool, informing future research.
Area of Science:
- Emergency Medicine
- Clinical Trials
- Health Services Research
Background:
- Syncope management in the emergency department (ED) shows significant practice variation.
- Shared decision-making (SDM) tools can potentially standardize care for low-to-intermediate-risk syncope patients.
Purpose of the Study:
- To evaluate the feasibility of a randomized controlled trial (RCT) for an SDM tool in ED syncope patients.
- To assess secondary outcomes including patient knowledge, involvement, and clinical outcomes.
Main Methods:
- An RCT was conducted with adults (≥30 years) experiencing unexplained syncope in an academic ED.
- Patients received either usual care or a personalized syncope decision aid (SynDA) to facilitate SDM.
- Feasibility was defined as enrolling 50 patients within 24 months; secondary outcomes included patient knowledge, involvement (OPTION-5), and 30-day clinical outcomes.
Main Results:
- 50 participants were enrolled over 24 months, meeting the primary feasibility endpoint.
- Patients using the SynDA tool showed significantly greater involvement (OPTION-5 scores: 52/100 vs. 27/100).
- No significant differences were observed in patient knowledge, care ratings, or serious clinical outcomes at 30 days.
Conclusions:
- An RCT of an SDM tool for unexplained syncope in the ED is feasible.
- The study demonstrated increased patient involvement with the SDM tool.
- Findings provide valuable insights and effect sizes for designing future SDM trials in syncope management.
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