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

Ijaz, Hamza; Wong, Christopher; Weaver, Jennifer; Mallinson, Trudy; Richards, Lorna; Saux, Maxine A. Le; Wang, Haijun; Ma, Yan; Meltzer, Andrew C.

doi:10.1016/j.ajem.2018.09.029

Cited by 10 publications

(10 citation statements)

References 17 publications

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“…To our knowledge this is the rst time the OPTION 5 tool has been used in obstetric observations. We found the tool easy to use in most encounters and interpret as was identi ed by Ijaz et.al (2018) in a study in an emergency department [36]. While the tool has been proven to provide a better understanding of the extent of shared decision than self-reported measures, there would be di culties when there are multiple and staged decisions [37].…”

Section: Discussionmentioning

confidence: 56%

Physician-patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: A mixed-method study

Doraiswamy

Billah

Karim

et al. 2020

Preprint

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Background: Caesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to understand more about the decision-making process surrounding CS by exploring physician-patient communication leading to informed-consent for the operation. Methods: We conducted a mixed-method study using structured observations with the Option Grid Collaborative’s OPTION5 tool and interviews with physicians and women between July and December 2018. Study participants were recruited from eight district public-sector hospitals. Eligibility criteria for facilities was ≥80 births every month; and for physicians, was that they had performed CSs. Women aged ≥18 years, providing consent, and delivering at a facility were included in the observation component; primigravid women delivering by CS were selected for the in-depth interviews. Quantitative data from observations were analysed using descriptive statistics. Following transcription and translation, a preliminary coding framework was devised for the qualitative data analysis. We combined both inductive and deductive approaches in our thematic analysis. Results: In total, 306 labour situations were observed, and interviews were conducted with 16 physicians and 32 women who delivered by CS (16 emergency CS; 16 elective CS). In 92.5% of observations of physician-patient communication in the context of labour situations, the OPTION5 mean scores were low (5-25 out of 100) for presenting options, patient partnership, describing pros/cons, eliciting patient preferences and integrating patient preferences. Interviews found that non-clinical factors prime both physicians and patients in favour of CS prior to the clinical encounter in which the decision to perform a CS is documented. These interactions were both minimal in content and limited in purpose, with consent being an artefact of a process involving little communication.Conclusions: Insufficient communication between physicians and patients is one of many factors driving increasing rates of caesarean section in Bangladesh. While this single clinical encounter provides an opportunity for practice improvement, interventions are unlikley to impact rates of CS without simultaneoulsy addressing physician, patient and health system contextual factors too.

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Section: Discussionmentioning

confidence: 56%

Physician-patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: A mixed-method study

Doraiswamy

Billah

Karim

et al. 2020

Preprint

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“… m This meta‐analysis by Gilbody et al 36 included RCTs in which the study population was composed of high‐risk patients (i.e., patients who had certain criteria to be deemed at high risk of depression before being randomization to screening vs usual care). …”

Section: Questionmentioning

confidence: 99%

“…One study showed little effort by physicians to engage patients in shared decision making when considering CT for abdominal pain. 36 Another study suggested that patient requests for CT are an anticipated reason for emergency physician ordering practices. 37 Visits for recurrent abdominal pain are also complicated by the diverse differential diagnosis for abdominal pain and the potential for similarity in presentations caused by very different pathology, such as ureteronephrolithiasis, 38 appendicitis, 39 cholecystitis, 40 mesenteric ischemia, 41 peptic ulcer disease, 42 abdominal aortic aneurysm, 43 bowel obstruction, 44 and ovarian pathology.…”

Section: Executive Summarymentioning

confidence: 99%

“…Part of the heterogeneity was explained by method of scoring and patient randomization (randomizing unselected patients vs. high‐risk patients). Visual inspection of forest plot presented by Gilbody et al 36 raised concerns for inconsistency because results differed across published studies.…”

Section: Questionmentioning

confidence: 99%

“…Consequently, each additional exposure to CT is believed to carry the same marginal/additional cancer risk. One study showed little effort by physicians to engage patients in shared decision making when considering CT for abdominal pain 36 . Another study suggested that patient requests for CT are an anticipated reason for emergency physician ordering practices 37 …”

Section: Introductionmentioning

confidence: 99%

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Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE‐2): Low‐risk, recurrent abdominal pain in the emergency department

Broder

Silva

Bellolio

et al. 2022

Academic Emergency Medicine

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This second Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE‐2) from the Society for Academic Emergency Medicine is on the topic “low‐risk, recurrent abdominal pain in the emergency department.” The multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding four priority questions for adult emergency department patients with low‐risk, recurrent, undifferentiated abdominal pain. The intended population includes adults with multiple similar presentations of abdominal signs and symptoms recurring over a period of months or years. The panel reached the following recommendations: (1) if a prior negative computed tomography of the abdomen and pelvis (CTAP) has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended; (2) if CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology; (3) we suggest that screening for depression and/or anxiety may be performed during the ED evaluation; and (4) we suggest an opioid‐minimizing strategy for pain control. EXECUTIVE SUMMARY The GRACE‐2 writing group developed clinically relevant questions to address the care of adult patients with low‐risk, recurrent, previously undifferentiated abdominal pain in the emergency department (ED). Four patient‐intervention‐comparison‐outcome‐time (PICOT) questions were developed by consensus of the writing group, who performed a systematic review of the literature and then synthesized direct and indirect evidence to formulate recommendations, following GRADE methodology. The writing group found that despite the commonality and relevance of these questions in emergency care, the quantity and quality of evidence were very limited, and even fundamental definitions of the population and outcomes of interest are lacking. Future research opportunities include developing precise and clinically relevant definitions of low‐risk, recurrent, undifferentiated abdominal pain and determining the scope of the existing populations in terms of annual national ED visits for this complaint, costs of care, and patient and provider preferences.

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Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

Hassankhani,

Valizadeh,

Amoukhteh

et al. 2023

Emerg Radiol

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Pediatric blunt trauma is a major cause of morbidity and mortality, and computed tomography (CT) imaging is vital for accurate evaluation and management. Pediatric trauma centers (PTCs) have selective CT practices, while non-PTCs may differ, resulting in potential variations in CT utilization. The objective of this study is to delineate disparities in CT utilization for pediatric blunt trauma patients between PTCs and non-PTCs. A systematic review and meta-analysis were conducted following established guidelines, searching PubMed, Scopus, and Web of Science up to March 3, 2023. All studies examining CT utilization in the management of pediatric (aged < 21 years) blunt trauma and specifying the type of trauma center(s) were included, and data were extracted and analyzed using STATA software version 17.0. An analysis of 30 studies revealed significant variations in CT scan utilization among pediatric blunt trauma patients across different types of trauma centers. PTCs exhibited lower pooled rates of abdominopelvic CT scans (35.4% vs. 44.9%, p < 0.01), cranial CT scans (36.9% vs. 42.9%, p < 0.01), chest CT scans (14.5% vs. 25.4%, p < 0.01), and cervical spine CT scans (23% vs. 45%, p < 0.01) compared to adult or mixed trauma centers (ATCs/MTCs). PTCs had a pooled rate of 54% for receiving at least one CT scan, while ATCs/MTCs had a higher rate of 69.3% (p < 0.05). The studies demonstrated considerable heterogeneity. These findings underscore the need to conduct further research to understand the reasons for the observed variations and to promote appropriate imaging usage, minimize radiation exposure, and encourage collaboration between pediatric and adult trauma centers.

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

Cited by 10 publications

References 17 publications

Physician-patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: A mixed-method study

Physician-patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: A mixed-method study

Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE‐2): Low‐risk, recurrent abdominal pain in the emergency department

Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers

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