DEVELOPMENT OF A PATIENT DECISION AID FOR SYNCOPE IN THE EMERGENCY DEPARTMENT: THE SYNDA TOOL

Title: DEVELOPMENT OF A PATIENT DECISION AID FOR SYNCOPE IN THE EMERGENCY DEPARTMENT: THE SYNDA TOOL

Probst MA, Hess EP, Breslin M, Sun BC, Richardson LD.

Purpose: We sought to develop a patient decision aid to promote shared decision-making for patients who present to the emergency department (ED) with syncope (i.e. transient loss of consciousness) and have no serious diagnosis identified.

Methods: Using input from thought leaders in the field of syncope and shared decision-making, we created a prototype of a paper-based decision aid to engage patients in the disposition decision (admission vs. discharge) after a negative ED work-up for syncope. We then conducted 1-on-1 interviews with 8 emergency physicians, 5 cardiologists, and 8 ED syncope patients to get detailed feedback on the content and design of the decision aid.

Results: We iteratively modified the decision aid after every interview using detailed feedback from each interviewee. The evidence-based decision aid, named SynDA, is written at an 8^th-grade reading level and includes 4 basic sections: 1) Explanation of syncope, 2) Explanation of future risks, 3) Personalized 30-day risk estimate, and 4) Disposition options. The communication of 30-day risk is stated in natural frequency (e.g. 2 patients out of 100) and graphically displayed using a color-coded, 100-man pictogram. At the end of the interview process, both patient and physician participants expressed satisfaction with the clarity and usability of the decision aid.

Conclusion:  Using interviews with patients and physicians, we developed an evidence-based, easy-to-use, patient decision aid, named SynDA, to facilitate shared decision-making for ED syncope patients with a negative diagnostic evaluation. We intend to evaluate this decision aid in a single-center randomized controlled trial.