Impact of an Educational Intervention on Emergency Department Residents' Knowledge and Perceptions of Sickle Cell Disease: A Pilot Study

Introduction: Individuals with sickle cell disease (SCD) have suboptimal experiences when presenting to the emergency department (ED), especially when seeking treatment for painful vaso-occlusive events. Despite evidence to the contrary, they are often perceived as drug-seekers, leading to inadequate pain management. Interventions focused on provider knowledge and perceptions may improve the quality of care provided to individuals with SCD in the ED. However, little is known regarding ED providers’ and even less regarding ED residents’ knowledge and perceptions of SCD. This pilot study aimed to assess the impact of an educational intervention on ED residents’ knowledge and perceptions regarding SCD.

Methods: A pilot quasi-experimental pre/post-test single-group intervention research design was employed, and the study sample consisted of 1st to 3rd-year residents enrolled in an emergency medicine residency program at a central Texas academic medical center (N=24). The educational intervention was a 40-minute interactive lecture that included patient ED experience audio recordings and was primarily focused on SCD pain and pain management. Primary outcomes were knowledge and perceptions regarding SCD. Knowledge was assessed using a 19-item questionnaire based on the lecture content and consisting of 4 domains: pathophysiology, screening, and prevalence; morbidity/mortality and treatment options; stroke; pain and ED management (domain and overall scale range: 0-100). Perceptions were assessed using a 19-item modified version of the General Perception About Sickle Cell Disease Patients Scale, which included 4 subscales: negative, positive, red-flag, and pain exaggeration perceptions (range: 0-100). Higher scores on each subscale indicated more pronounced perceptions, positive and negative subscales for respective perceptions, red-flag subscale for drug-seeking concerns, and pain exaggeration subscale for the belief that pain exaggeration among patients with SCD is not motivated by drug-seeking. Additionally, quantitative (5-point Likert scale) and qualitative items were used to seek feedback regarding the intervention at post-test. Data were analyzed using descriptive and inferential statistics (paired t-tests, Wilcoxon signed ranks tests). Cronbach’s alphas were assessed for perception scales, and statistical significance was set at p<0.25, as is acceptable for pilot studies.

Results: A total of 17 residents attended the lecture and N=16 completed both pre-test and post-test surveys (response rate=94.1%). All participants were aged between 25 and 35 years; the plurality were second year residents (43.8%), and over one-half were male (56.3%) and White (62.5%). Overall baseline knowledge was suboptimal, with a mean score of 52.3±14.1. Participants had the highest knowledge regarding SCD morbidity/mortality and treatment (62.5±20.5) and the lowest knowledge regarding SCD strokes (34.4±23.9). However, there was a significant (p<0.0001) 40-point increase in overall knowledge from pre- to post-test, with the most knowledge gained in the stroke subscale (53-point increase). Additionally, participants had low negative (10.2±8.2) and moderate positive (54.3±33.6), red-flag (50.8±14.0), and pain exaggeration (68.8±19.3) perceptions at baseline. Significant (p<0.25) improvements (pre- to post-test change score; p-value) were observed in 3 out of the 4 perceptions domains [negative (7.0; p=0.0068), positive (12.9; p=0.0957), and red-flag (23.8; p= p=0.0011)]. All perceptions scale reliabilities were acceptable (≥0.7). Participants rated the lecture as excellent (4.6±0.8) and found the information gained extremely useful (4.6±0.8) for the future care of patients with SCD. They also reported the incorporation of patient experience voices as the most impactful aspect of the intervention.

Conclusion: This pilot study showed that a 40-minute interactive educational intervention focusing on SCD pain and pain management that also incorporated patient experience audio recordings could be a valuable tool for enhancing ED residents’ knowledge and perceptions regarding SCD, especially in decreasing red-flag perceptions. However, further studies on larger and more diverse samples are needed to assess its impact more comprehensively.