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Exploring the attitudes & practices of shared decision-making for CT scan use in emergency department patients with abdominal pain

Published:September 18, 2018DOI:https://doi.org/10.1016/j.ajem.2018.09.029

      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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      References

        • Kocher K.E.
        • Meurer W.J.
        • Fazel R.
        • Scott P.A.
        • Krumholz H.M.
        • Nallamothu B.K.
        National trends in use of computed tomography in the emergency department.
        Ann Emerg Med. 2011; 58
        • Green S.M.
        When do clinical decision rules improve patient care?.
        Ann Emerg Med. 2013; 62: 132-135
        • Huckins D.S.
        • Simon H.K.
        • Copeland K.
        • Spiro D.M.
        • Gogain J.
        • Wandell M.
        A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain.
        Am J Emerg Med. 2013; 31 (Available from:): 1368-1375
        • Baumann B.M.
        • Chen E.H.
        • Mills A.M.
        • et al.
        Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure.
        Ann Emerg Med. 2011; 58: 1-7
        • Kanzaria H.K.
        • Brook R.H.
        • Probst M.A.
        • Harris D.
        • Berry S.H.
        • Hoffman J.R.
        Emergency physician perceptions of shared decision-making.
        Acad Emerg Med. 2015; 22: 399-405
        • Probst M.A.
        • Kanzaria H.K.
        • Frosch D.L.
        • et al.
        Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study.
        Academic Emergency Medicine, 2016: 375-381
        • Probst M.A.
        • Kanzaria H.K.
        • Schoenfeld E.M.
        • et al.
        Shared decision-making in the emergency department: a guiding framework for clinicians.
        Ann Emerg Med. 2017; 70: 688-695
        • Degner L.F.
        • Sloan J.A.
        • Venkatesh P.
        The Control Preferences Scale.
        Can J Nurs Res. 1997; 29: 21-43
        • Elwyn G.
        • Hutchings H.
        • Edwards A.
        • et al.
        The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks.
        Health Expect. 2005; 8: 34-42
      1. Observer OPTION 5 Training [Internet].
        (Available from:)
        • Elwyn G.
        • Tsulukidze M.
        • Edwards A.
        • Légaré F.
        • Newcombe R.
        Using a “talk” model of shared decision making to propose an observation-based measure: observer OPTION5 item.
        Patient Educ Couns. 2013; 93: 265-271
        • Gravel K.
        • Légaré F.
        • Graham I.D.
        Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions.
        Implement Sci. 2006; 1
        • Roh H.
        • Park K.H.
        A scoping review: communication between emergency physicians and patients in the emergency department.
        J Emerg Med. 2016; 50 (Available from:): 734-743
        • Chen E.H.
        • Kanzaria H.K.
        • Itakura K.
        • Booker-Vaughns J.
        • Yadav K.
        • Kane B.G.
        The role of education in the implementation of shared decision-making in emergency medicine: a research agenda.
        Acad Emerg Med. 2016; 23: 1362-1367
        • Hess E.P.
        • Marin J.
        • Mills A.
        Medically unnecessary advanced diagnostic imaging and shared decision-making in the emergency department: opportunities for future research.
        Acad Emerg Med. 2015; 22: 475-477
        • Griffey R.T.
        • McNaughton C.D.
        • McCarthy D.M.
        • et al.
        Shared decision making in the emergency department among patients with limited health literacy: beyond slower and louder.
        Acad Emerg Med. 2016; 23 (Available from:): 1403-1409
        • Meltzer A.C.
        • Baumann B.M.
        • Chen E.H.
        • Shofer F.S.
        • Mills A.M.
        Poor sensitivity of a modified Alvarado score in adults with suspected appendicitis.
        Ann Emerg Med. 2013; 62: 126-131
        • Pines J.M.
        • Carpenter C.R.
        • Raja A.S.
        • Schuur J.D.
        Evidence-based emergency care: diagnostic testing and clinical decision rules [internet].
        (Available from:)
        • Straus S.E.
        • Tetroe J.
        • Graham I.D.
        Knowledge Translation in Health Care: Moving from Evidence to Practice.
        2009
        • Kanzaria H.K.
        • McCabe A.M.
        • Meisel Z.M.
        • et al.
        Advancing patient-centered outcomes in emergency diagnostic imaging: a research agenda.
        Acad Emerg Med. 2015; 22: 1435-1446
        • Coylewright M.
        • Shepel K.
        • LeBlanc A.
        • et al.
        Shared decision making in patients with stable coronary artery disease: PCI choice.
        PLoS One. 2012; 7
        • Hess E.P.
        • Hollander J.E.
        • Schaffer J.T.
        • et al.
        Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial.
        BMJ. 2016; (Available from:): i6165
        • Grimm P.
        Social desirability bias [internet].
        in: Wiley International Encyclopedia of Marketing. 2010 (Available from:)
        • de las Cuevas C.
        • Peñate W.
        Validity of the control preferences scale in patients with emotional disorders.
        in: Patient Prefer Adherence. 10. 2016: 2351-2356