Does Shared Decision Making Actually Occur in the Emergency Department? Looking at It from the Patients’ Perspective

Abstract

Objective: We sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients' perspectives.Methods: Utilizing a cross-sectional, multisite approach, we administered an instrument, consisting of two validated SDM assessment tools-the CollaboRATE and the SDM-Q-9-and one newly developed tool to a sample of ED patients. Our primary outcome was the occurrence of SDM in the clinical encounter, as defined by participants giving "top-box" scores on the CollaboRATE measure, and the ability of patients to identify the topic of their SDM conversation. Secondary outcomes included the content of the SDM conversations, as judged by patients, and whether patients were able to complete each of the two validated scales included in the instrument.Results: After exclusions, 285 participants from two sites completed the composite instrument. Just under half identified as female (47%) or as white (47%). Roughly half gave top-box scores (i.e., indicating optimal SDM) on the CollaboRATE scale (49%). Less than half of the participants were able to indicate a decision they were involved in (44%), although those who did gave high scores for such conversations (73/100 via the SDM-Q-9 tool). The most frequently identified decisions discussed were admission versus discharge (19%), medication options (17%), and options for follow-up care (15%).

Engaging consumers and health professionals in collaborative decision‐making to optimize care

“…Our findings provided contextual understandings of the perspectives of consumers and health professionals. The findings are consistent with the literature highlighting that collaboration and shared decision‐making between consumers and health professionals contribute to benefits in the management of consumer care (Schoenfeld et al, 2019; Wright et al, 2018). This collaboration is generally established within a context of personal and professional perceptions and understandings as consumers and health professionals work together to plan and attain shared goals (Allen et al, 2019; Born et al, 2017; Embrett & Randall, 2018).…”

“…In these situations, health professionals may simply adopt the path of least resistance and give way to consumer expectations (Ives et al, 2018; Keijzers et al, 2018). Hence, to effectively engage in a shared decision‐making process, health professionals need to feel supported (Schoenfeld et al, 2019). Finding a balance focused on consumer‐centered care among consumers, caregivers, and health professionals is imperative (Ives et al, 2018; Yu et al, 2019).…”

Patients’ and physicians’ gender and perspective on shared decision-making: A cross-sectional study from Dubai

“…Implementing SDM in clinical practice has been associated with improved patients' selfreported outcomes and their understanding of risks, as well as greater satisfaction with the consultation process [6][7][8]. In addition, SDM improves quality of care and patient adherence to medication, and consequently contributes to the optimization of health costs [7].…”

Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study

“…Reports about SDM, ACP, and code status in the COVID-19 context are scarce. The process of SDM has been studied earlier in a general ER environment and showed a 49% compliance rate using a composite instrument [ 15 ]. Other research has shown that there was no difference in frequency of code status documentation in COVID-19 patients opposed to the pre-COVID cohort [ 16 ].…”