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Patient Preferences Regarding Shared Decision Making in the Emergency Department: Findings From a Multisite Survey
Author(s) -
Schoenfeld Elizabeth M.,
Kanzaria Hemal K.,
Quigley Denise D.,
Marie Peter St.,
Nayyar Nikita,
Sabbagh Sarah H.,
Gress Kyle L.,
Probst Marc A.
Publication year - 2018
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.13499
Subject(s) - medicine , emergency department , family medicine , preference , medical decision making , scale (ratio) , patient participation , clinical decision making , medline , nursing , physics , quantum mechanics , political science , law , economics , microeconomics
Objectives As shared decision making ( SDM ) has received increased attention as a method to improve the patient‐centeredness of emergency department ( ED ) care, we sought to determine patients’ desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to SDM in the ED . Methods We surveyed a cross‐sectional sample of adult ED patients at three academic medical centers across the United States. The survey included 32 items regarding patient involvement in medical decisions including a modified Control Preference Scale and questions about barriers and facilitators to SDM in the ED . Items were developed and refined based on prior literature and qualitative interviews with ED patients. Research assistants administered the survey in person. Results Of 797 patients approached, 661 (83%) agreed to participate. Participants were 52% female, 45% white, and 30% Hispanic. The majority of respondents (85%–92%, depending on decision type) expressed a desire for some degree of involvement in decision making in the ED , while 8% to 15% preferred to leave decision making to their physician alone. Ninety‐eight percent wanted to be involved with decisions when “something serious is going on.” The majority of patients (94%) indicated that self‐efficacy was not a barrier to SDM in the ED . However, most patients (55%) reported a tendency to defer to the physician's decision making during an ED visit, with about half reporting they would wait for a physician to ask them to be involved. Conclusion We found that the majority of ED patients in our large, diverse sample wanted to be involved in medical decisions, especially in the case of a “serious” medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit. After fully explaining the consequences of a decision, clinicians should make an effort to explicitly ascertain patients’ desired level of involvement in decision making.