A Randomized Controlled Trial of a Digital Patient Decision Tool to Increase Sexually Transmitted Infection Testing in the Emergency Department.

Abstract

To evaluate the efficacy of a digital patient decision aid, Sexually Transmitted Infection Check in the Emergency Room (STIckER), in increasing sexually transmitted infection testing among adolescents and young adults in the emergency department (ED). We conducted a randomized controlled trial in adult and pediatric EDs at a large urban academic medical center. We randomized health care clinicians to deliver either the STIckER digital decision aid or usual care to sexually active adolescents and young adults patients aged 14 to 24 years. The tool, developed through human-centered design, provided personalized sexually transmitted infection testing recommendations and values clarification exercises via smartphone. The primary outcome was documentation of gonorrhea/chlamydia testing. Secondary outcomes included extragenital testing, patient-reported decisionmaking measures, and implementation. We conducted descriptive statistics of patient-level and health care provider-level outcomes by study arms. We estimated the efficacy of STIckER using log-binomial regression. We randomized 44 health care clinicians and enrolled 139 adolescents and young adult participants (median age 19 years). Participants in the STIckER arm were 1.76 times more likely to receive gonorrhea/chlamydia testing (95% confidence interval, 1.10 to 3.00) and 4.56 times more likely to receive pharyngeal testing (95% confidence interval, 1.30 to 28.66). Participants in the STIckER arm reported greater clarity about testing options and higher satisfaction with ED care. Adolescents and young adults and health care clinicians rated the tool as highly acceptable, appropriate, and feasible. A digital, patient-centered decision aid increased sexually transmitted infection testing among adolescents and young adults in the ED. STIckER is feasible for integration into ED clinical workflows and may represent a scalable strategy to expand equitable sexual health screening in acute care settings.