Shared Decision‐Making in the Selection of Outpatient Analgesics for Older Individuals in the Emergency Department

Abstract

OBJECTIVES To assess the relationship between older patients’ perceptions of shared decision making in the selection of an analgesic to take at home for acute musculoskeletal pain and 1) patient satisfaction with the analgesic and 2) changes in pain scores at one week. DESIGN Cross-sectional study. SETTING Single academic emergency department. PARTICIPANTS Individuals age 65 or older with acute musculoskeletal pain. MEASUREMENTS Two components of shared decision making were assessed: 1) information provided to the patient about the medication choice; and 2) patient participation in the selection of the analgesic. Optimal satisfaction with the analgesic was defined as being “a lot” satisfied. Pain scores were assessed in the ED and at one week using a 0-to-10 scale. RESULTS Of 159 patients reached by phone, 111 patients met all eligibility criteria and completed the survey. Half (52%) of patients reported receiving information about pain medication options, and one third (31%) reported participating in the analgesic selection. Patients who received information were more likely to report optimal satisfaction with the pain medication than those who did not (67% vs. 34%; p<0.001). Patients who participated in the decision were also more likely to report optimal satisfaction with the analgesic (71% vs. 43%; p<0.01) and had a greater average decrease in pain score (4.1 vs. 2.9; p=0.05). After adjusting for measured confounders, patients who reported receiving information remained more likely to report optimal satisfaction with the analgesic (63% vs. 38%; p=0.04). CONCLUSION These results provide preliminary evidence that shared decision making in analgesic selection for older patients with acute musculoskeletal pain may improve outcomes.

Delayed Telephone Consent in Emergency Medicine Research

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The Burden of Acute Heart Failure on U.S. Emergency Departments

“…Social, behavioral, and environmental factors strongly influence one's ability to implement a healthy lifestyle required to optimally manage a chronic illness (44,45). Further, patient engagement through shared decision making (46–48) has been successful in other ED-based treatment strategies (49–54) and is an important area to investigate in AHF. Combining comprehensive risk stratification and strategies to overcome self-care barriers, along with shared decision making, may increase the likelihood of successful outpatient transition after either an ED stay or brief management in an observation unit.…”

Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda

“…In the ED, SDM is associated with greater satisfaction with discharge pain medications and a greater average pain reduction at 1 week. 17,80 Older adults often discontinue analgesics due to unexpected and undesirable side effects, and SDM has the potential to help patients and providers identify appropriate treatments and mitigate or at least anticipate these side effects. SDM also may make these challenging patient care decisions more rewarding for emergency physicians: primary physicians who receive SDM training report greater satisfaction with patient interactions and greater confidence in their ability to treat patients with chronic pain.…”