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Emergency Physician Perceptions of Shared Decision‐making
Author(s) -
Kanzaria Hemal K.,
Brook Robert H.,
Probst Marc A.,
Harris Dustin,
Berry Sandra H.,
Hoffman Jerome R.
Publication year - 2015
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12627
Subject(s) - medicine , focus group , emergency department , medical emergency , perception , survey research , family medicine , nursing , applied psychology , psychology , neuroscience , business , biology , marketing
Objectives Despite the potential benefits of shared decision‐making ( SDM ), its integration into emergency care is challenging. Emergency physician ( EP ) perceptions about the frequency with which they use SDM , its potential to reduce medically unnecessary diagnostic testing, and the barriers to employing SDM in the emergency department ( ED ) were investigated. Methods As part of a larger project examining beliefs on overtesting, questions were posed to EP s about SDM . Qualitative analysis of two multispecialty focus groups was done exploring decision‐making around resource use to generate survey items. The survey was then pilot‐tested and revised to focus on advanced diagnostic imaging and SDM . The final survey was administered to EP s recruited at four emergency medicine ( EM ) conferences and 15 ED group meetings. This report addresses responses regarding SDM . Results A purposive sample of 478 EP s from 29 states were approached, of whom 435 (91%) completed the survey. EP s estimated that, on average, multiple reasonable management options exist in over 50% of their patients and reported employing SDM with 58% of such patients. Respondents perceived SDM as a promising solution to reduce overtesting. However, despite existing research to the contrary, respondents also commonly cited beliefs that 1) “many patients prefer that the physician decides,” 2) “when offered a choice, many patients opt for more aggressive care than they need,” and 3) “it is too complicated for patients to know how to choose.” Conclusions Most surveyed EP s believe SDM is a potential high‐yield solution to overtesting, but many perceive patient‐related barriers to its successful implementation.