Development and Testing of Shared Decision Making Interventions for Use in Emergency Care: A Research Agenda

Melnick, Edward R.; Probst, Marc A.; Schoenfeld, Elizabeth M.; Collins, Sean P.; Breslin, Maggie; Walsh, Cheryl; Kuppermann, Nathan; Dunn, Patrick; Abella, Benjamin S.; Boatright, Dowin; Hess, Erik P.

doi:10.1111/acem.13045

Cited by 32 publications

(33 citation statements)

References 51 publications

(58 reference statements)

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“…2 Although research in the field of SDM has been ongoing for several decades, recent attention to the opportunities for SDM in the Emergency Department (ED) has heightened the need for ED-specific research. 3,4 Several studies have examined SDM from the perspective of the ED physician, recognizing the importance of the physician-as-stakeholder. 5–7 These studies have found that physicians often believe their patients do not want to be involved in decisions in the setting of emergency care.…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Analysis of Patients’ Perceptions of Shared Decision Making in the Emergency Department: “Let Me Know I Have a Choice”

Schoenfeld

Goff

Downs

et al. 2018

Academic Emergency Medicine

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Background and Objectives: Despite increasing attention to the use of Shared Decision-Making (SDM) in the Emergency Department (ED), little is known about ED patients’ perspectives regarding this practice. We sought to explore the use of SDM from the perspectives of ED patients, focusing on what affects patients’ desired level of involvement and what barriers and facilitators patients find most relevant to their experience. Methods: We conducted semi-structured interviews with a purposive sample of ED patients or their proxies at two sites. An interview guide was developed from existing literature and expert consensus, and based on a framework underscoring the importance of both knowledge and power. Interviews were recorded, transcribed and analyzed in an iterative process by a 3-person coding team. Emergent themes were identified, discussed, and organized. Results: Twenty-nine patients and proxies participated. The mean age of participants was 56 years (range 20 to 89), and 13 were female. Participants were diverse in regards to race/ethnicity, education, number of previous ED visits, and presence of chronic conditions. All participants wanted some degree of involvement in decision-making. Participants who made statements suggesting high self-efficacy and those who expressed mistrust of the healthcare system or previous negative experiences wanted a greater degree of involvement. Facilitators to involvement included familiarity with the decision at hand, physicians’ good communication skills, and clearly-delineated options. Some participants felt that their own relative lack of knowledge, compared to that of the physicians, made their involvement inappropriate or unwanted. Many participants had no expectation for SDM and although they did want involvement when asked explicitly, were otherwise likely to defer to physicians without discussion. Many did not recognize opportunities for SDM in their clinical care. Conclusions: This exploration of ED patients’ perceptions of SDM suggests that most patients want some degree of involvement in medical decision-making but more proactive engagement of patients by clinicians is often needed. Further research should examine these issues in a larger and more representative population.

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Section: Introductionmentioning

confidence: 99%

A Qualitative Analysis of Patients’ Perceptions of Shared Decision Making in the Emergency Department: “Let Me Know I Have a Choice”

Schoenfeld

Goff

Downs

et al. 2018

Academic Emergency Medicine

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“…Instead of trying to further validate CT decision tools in low-risk cohorts, we should focus on physician and patient counseling in regard to low disease prevalence and incorporate this guidance within a shared decisionmaking intervention. 3 When compared with "usual care" in a randomized controlled trial, such an intervention may be significantly more effective in reducing CT imaging in low-risk populations.…”

Section: Abandoning Further Study Of the Application Of Computed Tomomentioning

confidence: 99%

Abandoning Further Study of the Application of Computed Tomography Decision Rules to Low-Risk Patients With Head Injury

deSouza

2018

Annals of Emergency Medicine

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“…20 In 2016, the Academic Emergency Medicine (AEM) Consensus Conference on SDM in the ED called for further research on the development and testing of SDM interventions and identified syncope as a relevant clinical scenario. 21 Priority research questions identified during this conference included how to communicate risk and uncertainty with patients, what tools can facilitate SDM, and what outcomes are suitable for SDM research in the ED.…”

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confidence: 99%

Shared Decision Making for Syncope in the Emergency Department: A Randomized Controlled Feasibility Trial

Probst

Lin

Sze

et al. 2020

Academic Emergency Medicine

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Objectives Significant practice variation is seen in the management of syncope in the emergency department (ED). We sought to evaluate the feasibility of performing a randomized controlled trial of a shared decision making (SDM) tool for low‐to‐intermediate–risk syncope patients presenting to the ED. Methods We performed a randomized controlled trial of adults (≥30 years) with unexplained syncope who presented to an academic ED in the United States. Patients with a serious diagnosis identified in the ED were excluded. Patients were randomized, 1:1, to receive either usual care or a personalized syncope decision aid (SynDA) meant to facilitate SDM. Our primary outcome was feasibility, i.e., ability to enroll 50 patients in 24 months. Secondary outcomes included patient knowledge, involvement (measured with OPTION‐5), rating of care, and clinical outcomes at 30 days post‐ED visit. Results After screening 351 patients, we enrolled 50 participants with unexplained syncope from January 2017 to January 2019. The most common reason for exclusion was lack of clinical equipoise to justify SDM (n = 124). Patients in the SynDA arm tended to have greater patient involvement, as shown by higher OPTION‐5 scores: 52/100 versus 27/100 (between‐group difference = −25.4, 95% confidence interval = −13.5 to −37.3). Both groups had similar levels of clinical knowledge, ratings of care, and serious clinical outcomes at 30 days. Conclusions Among ED patients with unexplained syncope, a randomized controlled trial of a shared decision‐making tool is feasible. Although this study was not powered to detect differences in clinical outcomes, it demonstrates feasibility, while providing key lessons and effect sizes that could inform the design of future SDM trials.

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Development and Testing of Shared Decision Making Interventions for Use in Emergency Care: A Research Agenda

Cited by 32 publications

References 51 publications

A Qualitative Analysis of Patients’ Perceptions of Shared Decision Making in the Emergency Department: “Let Me Know I Have a Choice”

A Qualitative Analysis of Patients’ Perceptions of Shared Decision Making in the Emergency Department: “Let Me Know I Have a Choice”

Abandoning Further Study of the Application of Computed Tomography Decision Rules to Low-Risk Patients With Head Injury

Shared Decision Making for Syncope in the Emergency Department: A Randomized Controlled Feasibility Trial

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