Information sheets for patients with acute chest pain: randomised controlled trial

Arnold, Jane; Goodacre, Steve; Bath, Peter A.; Price, Jonathan

doi:10.1136/bmj.b541

Cited by 34 publications

(28 citation statements)

References 19 publications

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“…10,12 Thus, concentration of future research on the following 2 questions may be more important: (1) how to maximize the reassurance value of diagnostic tests and (2) whether reassurance should be targeted to particular patients. Three trials have reported that brief interventions to increase the acceptability of negative test results lead to improved reassurance, [42][43][44] and theoretical work supports this finding. 45 Targeting interventions (including reassurance and cognitive-based rehabilitation) to patients at higher risk of persistent symptoms is effective in patients with low back pain, 46 and diagnostic testing accompanied by enhanced explanation can be an appropriate strategy.…”

Section: Recommendations For Research and Practicementioning

confidence: 92%

Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease

Rolfe¹,

Burton²

2013

JAMA Intern Med

150

103

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Importance: Diagnostic tests are often ordered by physicians in patients with a low pretest probability of disease to rule out conditions and reassure the patient.Objective: To study the effect of diagnostic tests on worry about illness, anxiety, symptom persistence, and subsequent use of health care resources in patients with a low pretest probability of serious illness.Evidence Acquisition: Systematic review and metaanalysis. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsychINFO, CINAHL, and ProQuest Dissertations electronic databases through December 31, 2011, for eligible randomized controlled trials. We independently identified studies for inclusion and extracted the data. Disagreements were resolved by discussion. We performed metaanalysis if heterogeneity was low or moderate (I 2 Ͻ50%).Results: Fourteen randomized controlled trials that included 3828 patients met the inclusion criteria and were analyzed with outcomes categorized as short term (Յ3 months) or long term (Ͼ3 months). Three trials showed no overall effect of diagnostic tests on illness worry (odds ratio, 0.87 [95% CI, 0.55-1.39]), and 2 showed no effect on nonspecific anxiety (standardized mean difference, 0.06 [Ϫ0.16 to 0.28]). Ten trials showed no overall long-term effect on symptom persistence (odds ratio, 0.99 [95% CI, 0.85-1.15]). Eleven trials measured subsequent primary care visits. We observed a high level of heterogeneity among trials (I 2 =80%). Meta-analysis after exclusion of outliers suggested a small reduction in visits after investigation (odds ratio, 0.77 [95% CI, 0.62-0.96]).Conclusions and Relevance: Diagnostic tests for symptoms with a low risk of serious illness do little to reassure patients, decrease their anxiety, or resolve their symptoms, although the tests may reduce further primary care visits. Further research is needed to maximize reassurance from medically necessary tests and to develop safe strategies for managing patients without testing when an abnormal result is unlikely.

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Section: Recommendations For Research and Practicementioning

confidence: 92%

Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease

Rolfe¹,

Burton²

2013

JAMA Intern Med

150

103

View full text Add to dashboard Cite

show abstract

“…The content of previous successful face-to-face CBT interventions for NCCP (Esler et al, 2003; Jonsbu, Dammen, Morken, Moum, & Martinsen, 2011; Potts, Lewin, Fox, & Johnstone, 1999; van Peski-Oosterbaan et al, 1999) was also used to guide development. The intervention built on a prior information only leaflet (Arnold et al, 2009), with the inclusion of techniques to target anxiety. The intervention booklet comprised three sections:…”

Section: Methodsmentioning

confidence: 99%

“…Such materials have been effective for anxiety disorders (Lewis, Pearce, & Bisson, 2012) and may be particularly useful within this setting (Esler et al, 2003). Brief information leaflets for chest pain patients within the ED have been shown to have an effect on psychological outcomes but no impact on chest pain (Arnold, Goodacre, Bath, & Price, 2009). The need for brief interventions that impact on both psychological and physical outcomes is apparent.…”

Section: Introductionmentioning

confidence: 99%

The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain

Webster

Thompson

Norman

et al. 2016

Psychology, Health & Medicine

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Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.

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“…Entsprechend sollten Überlegungen angestellt werden, wie Interventionen dieser Art besser in die Routineversorgung integriert werden können. Auch vorherige Studien [Mayou et al, 1999;Sanders et al, 1997] [Arnold et al, 2009].…”

Section: Disclosure Statementunclassified

Krankheitsrepräsentationen bei nicht-kardialem Brustschmerz - eine verhaltensmedizinische Kurzintervention

Schroeder¹,

Schmid²,

Martin³

2013

Verhaltenstherapie

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Summary Illness Perceptions in Noncardiac Chest Pain -A Brief Psychological InterventionBackground: Noncardiac chest pain is a frequent condition that is likely to develop a chronic course. Simply reassuring patients about nonpathological diagnostic test results has proved to be insufficient to effectively reduce dysfunctional illness representations and worry. The aim of the study was to develop a brief psychological intervention focussing on subjective illness representations and to evaluate its practicability. Patients and Methods: 57 patients with noncardiac chest pain participated. Illness representations and chest pain characteristics as well as the participants' subjective evaluation of the intervention were assessed. Results: Subjective ratings by the participants were mostly positive, but of all patients eligible for the intervention 42% declined to participate. In comparison to the refusers, the intervention participants were younger and reported stronger dysfunctional illness representations and higher pain intensity. Conclusion: It remains a challenge to affect patients with noncardiac chest pain with early psychological interventions, in particular patients who feel only mildly impaired. Nevertheless, our results show that a low-threshold intervention is applicable and is mainly seen as effective. Schlüsselwörter

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Information sheets for patients with acute chest pain: randomised controlled trial

Cited by 34 publications

References 19 publications

Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease

Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease

The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain

Krankheitsrepräsentationen bei nicht-kardialem Brustschmerz - eine verhaltensmedizinische Kurzintervention

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