- The study addressed the challenge of increasing sexually transmitted infection testing among adolescents and young adults in the emergency department.
- This randomized controlled trial included 44 clinicians and 139 adolescent and young adult participants aged 14 to 24 years.
- STIckER participants were 1.76 times more likely to receive gonorrhea/chlamydia testing (95% CI, 1.10-3.00).
- The authors concluded that this digital, patient-centered decision aid increased sexually transmitted infection testing.
- This tool is feasible for integration into emergency department workflows, potentially expanding equitable sexual health screening.
Enhancing STI Screening in the Emergency Department
Sexually transmitted infections (STIs) continue to represent a significant public health challenge, with a disproportionate burden on adolescents and young adults [1]. The emergency department (ED) serves as a frequent point of contact for this demographic, yet it remains an underutilized setting for STI screening due to persistent barriers like clinician time constraints and patient discomfort discussing sexual health [2]. While digital health applications have shown effectiveness in other clinical contexts [3, 4, 5], their successful deployment in acute care for sensitive topics requires careful design that considers the specific needs of both patients and providers [6, 7, 8]. A recent randomized controlled trial evaluated a digital patient decision aid, STIckER (Sexually Transmitted Infection Check in the Emergency Room), designed to address these specific challenges and increase STI testing among young people in the ED [9].
STIckER: A Digital Tool for Informed Decisions
The investigation centered on a digital patient decision aid, the Sexually Transmitted Infection Check in the Emergency Room (STIckER) tool, which was evaluated in a randomized controlled trial at a large urban academic medical center. The study randomized healthcare clinicians in adult and pediatric EDs to either provide usual care or to use the STIckER tool with their sexually active patients aged 14 to 24 years. The tool itself was developed using a human-centered design process, meaning it was built with direct input from adolescents and clinicians to ensure it was intuitive and relevant. Delivered via smartphone, STIckER provided patients with personalized STI testing recommendations based on their risk factors and included values clarification exercises, which are structured prompts designed to help patients weigh the benefits and drawbacks of testing in the context of their personal priorities. The primary endpoint was documented gonorrhea and chlamydia testing, with secondary outcomes including extragenital testing rates and patient-reported measures of decision quality. The study's efficacy was estimated using log-binomial regression, a statistical method used to calculate the relative risk or likelihood of an outcome occurring in one group compared to another.
Quantifying the Impact on Testing Rates
The trial enrolled 139 adolescent and young adult participants with a median age of 19 years, who were managed by 44 randomized healthcare clinicians. The findings demonstrated a clear effect on screening practices. Participants in the STIckER arm were 1.76 times more likely to receive gonorrhea and chlamydia testing compared to those receiving usual care (95% confidence interval, 1.10 to 3.00). This increase is clinically significant as it directly addresses two of the most common bacterial STIs, which are frequently asymptomatic and can lead to serious sequelae such as pelvic inflammatory disease if left untreated. The intervention's impact extended to more comprehensive screening protocols as well. Participants using the STIckER tool were 4.56 times more likely to receive pharyngeal testing for gonorrhea and chlamydia (95% confidence interval, 1.30 to 28.66). This is a particularly notable result, as extragenital infections are often overlooked in routine practice but serve as important reservoirs for ongoing transmission. The tool's ability to prompt for both genital and extragenital screening represents a more thorough approach to sexual health in the acute care setting.
Patient and Clinician Perspectives on the Tool
Beyond increasing testing rates, the intervention had a positive effect on the patient experience. Participants in the STIckER arm reported greater clarity about their testing options and higher satisfaction with their ED care. This suggests the tool successfully empowered patients to participate in their own health decisions, transforming a potentially awkward conversation into a structured, private, and informative process. The practical success of any new clinical intervention hinges on its acceptance by end-users. In this trial, the STIckER tool received high marks from both sides of the clinical encounter. Both the adolescent and young adult participants and the healthcare clinicians rated the tool as highly acceptable, appropriate, and feasible for the ED environment. This dual endorsement is critical; it indicates that the tool not only meets patient needs but also integrates smoothly into demanding clinical workflows without creating an undue burden, a key factor for scalability and sustained use.
Clinical Implications for ED Practice
The results of this trial provide strong evidence that a targeted digital decision aid can meaningfully increase STI screening in the ED. The STIckER tool was directly associated with a higher likelihood of testing, with participants being 1.76 times more likely to receive gonorrhea/chlamydia testing and 4.56 times more likely to receive pharyngeal testing. For the practicing clinician, this demonstrates that a structured, patient-facing digital tool can effectively overcome common barriers to discussing and ordering sensitive tests in a time-pressured environment. Furthermore, the study confirmed that STIckER is feasible for integration into ED clinical workflows. The high ratings of acceptability and appropriateness from the 44 participating clinicians suggest that such tools are not an impediment to care but rather an efficient adjunct. The positive reception from the 139 young patients underscores the value of patient-centered technology in improving the care experience. Ultimately, the STIckER tool serves as a model for a scalable strategy to expand equitable sexual health screening in acute care settings. By standardizing and personalizing the screening conversation, it offers a practical way for EDs to address a critical public health need and improve preventive care for a vulnerable population.
References
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