Abstract
Background
Shared decision-making (SDM) has been studied in the emergency department (ED) in
relation to hospital admissions but not for CT scan utilization. CT scans are a common
imaging modality with high accuracy that emit considerable ionizing radiation. This
study has three aims: to measure provider and patient preference for SDM; to evaluate
patient involvement in the decision to order a CT scan; and to determine the association
between patient involvement and CT utilization.
Methods
In this prospective study, stable ED patients with abdominal pain with CT imaging
as a likely diagnostic tool, were screened and consented. The Control Preferences
Scale assessed patient and provider baseline decision-making preference. Using the
OPTION-5 tool, providers were assessed in each encounter for the extent to which they
engaged patients in discussions. The association between the Control Preferences Scale,
the OPTION-5 score and ultimate CT utilization was evaluated.
Results
Twenty-nine encounters were observed. CT was considered in 70% (n = 20) of encounters and ordered in 55% (n = 16). 62% of patients and 59% of providers reported that they prefer “shared responsibility”
when making treatment decisions. In >80% of encounters, provider's showed no or minimal effort when discussing whether to perform a CT scan. Provider or patient preference was
not associated with patient involvement. Patient involvement was not associated with
CT utilization.
Conclusions
High rates of provider and patient preference to use SDM for treatment plans were
reported but providers were rarely observed engaging patients with abdominal pain
in the decision to order a CT scan.
Keywords
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Article Info
Publication History
Published online: September 18, 2018
Accepted:
September 17,
2018
Received in revised form:
September 10,
2018
Received:
August 9,
2018
Footnotes
☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
