A Digital Patient Decision Aid to Increase Sexually Transmitted Infection Testing in the Emergency Department: Protocol for a Pilot Randomized Controlled Trial of the STIckER (STI Check in the Emergency Room) Study
Notice bibliographique
Résumé
Background: Rising rates of sexually transmitted infections (STIs) among adolescents and young adults are concerning. Emergency department (ED) visits offer a unique opportunity to increase STI testing. However, providers in the ED may not have the time or self-efficacy to screen patients, and patients may be unable to initiate discussion on their STI care needs. A patient decision aid may improve the effectiveness and efficiency of the ED encounter for STI testing. Objective: This study aims to pilot STI Check in the Emergency Room (STIckER) app, a shared decision-making aid for urinary, oral, and rectal gonorrhea and chlamydia testing among adolescents and young adults, and assess STIckER's efficacy and implementation outcomes in an adult and pediatric ED. Methods: We are conducting a parallel-group, two-arm provider-randomized controlled pilot trial in the adult and pediatric EDs at an urban academic medical center. Fifty providers were randomized 1:1 to intervention (trained on STIckER) or control (standard of care). Adolescents and young adults aged 14-24 years, English-speaking, and sexually active within the past 6 months are recruited during eligible shifts and assigned to the study arm of their provider. The standard of care comparator consists of usual provider-initiated STI discussions and testing without access to the decision aid; control participants receive a QR code directing them to a simple landing page encouraging them to ask their provider about STI testing. The planned enrollment target was 44 providers and 140 adolescent and young adult participants. Primary outcome is preliminary efficacy, defined as the proportion of adolescents and young adults receiving gonorrhea and chlamydia testing based on electronic medical record (EMR) review. Secondary outcomes include extragenital testing uptake, STI positivity rates, decisional conflict, and perceived level of shared decision-making. Implementation outcomes include feasibility, acceptability, appropriateness (using acceptability of intervention measure, intervention appropriateness measure, and feasibility of intervention measure), and provider self-efficacy. Data will be analyzed using descriptive statistics and regression models, with mixed-effects models applied if clustering by provider is detected. Exploratory analyses will examine differences by patient age, gender, and sexual identity, and provider characteristics. Results: Between September 2023 and July 2025, we completed recruitment of 44 providers and 139 adolescent and young adult participants across both adult and pediatric EDs. Enrollment targets were met, with high fidelity to intervention delivery and strong rates of survey completion by both patients and providers. Final data cleaning and analyses are underway, and primary results are expected to be available in late 2025. Conclusions: This pilot trial will provide critical data on the feasibility, acceptability, and preliminary efficacy of a digital SDM tool to increase STI testing in the ED. Findings will inform the design of a future multisite trial and the potential for scaling STIckER to support equitable, patient-centered STI screening across diverse clinical settings.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,022 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,005 | 0,003 |
| Méta-épidémiologie (sens large) | 0,009 | 0,004 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,003 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,006 | 0,008 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,069 | 0,009 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».