2016
DOI: 10.1111/acem.13074
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Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda

Abstract: Older emergency department patients have high rates of serious illness and injury, are at high risk for side effects and adverse events from treatments and diagnostic tests, and in many cases, have nuanced goals of care in which pursuing the most aggressive approach is not desired. Although some forms of shared decision making (SDM) are commonly practiced by emergency physicians caring for older adults, broader use of SDM in this setting is limited by a lack of knowledge of the types of patients and conditions… Show more

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Cited by 22 publications
(14 citation statements)
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References 87 publications
(93 reference statements)
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“…Identifying dementia should not delay access to care. While obtaining consent for time‐dependent emergencies is often unnecessary, most ED decisions are not time dependent, and recognizing the presence or absence of dementia is essential for establishing capacity while engaging in shared decision making regarding tests, interventions, and disposition decisions . In addition, dementia severity varies between patients and none of the ED screening instruments evaluates dementia severity or decisional capacity …”
Section: Discussionmentioning
confidence: 99%
“…Identifying dementia should not delay access to care. While obtaining consent for time‐dependent emergencies is often unnecessary, most ED decisions are not time dependent, and recognizing the presence or absence of dementia is essential for establishing capacity while engaging in shared decision making regarding tests, interventions, and disposition decisions . In addition, dementia severity varies between patients and none of the ED screening instruments evaluates dementia severity or decisional capacity …”
Section: Discussionmentioning
confidence: 99%
“…If the goals of care are consistent with possible hospitalization and additional diagnostic testing and therapeutic interventions, these defined goals can then act as a framework for subsequent goal‐directed decision making as they are crucial to achieving desired outcomes . The translation of broader goals to an actionable outcomes‐based plan of care requires dialog between providers, who supply medical expertise and qualitative assessment of future risk, and patients, families, and caregivers, who provide the personalized contextual factors motivating care goals and preferences .…”
Section: Discussionmentioning
confidence: 99%
“…Central to management of the geriatric trauma patient is the evolving concept of shared decision‐making, with the cognitively intact patient or with alternate health decision‐makers in those patients lacking decision‐making capacity . Informed decision‐making in this setting requires an understanding of likely prognosis with respect to survival and functional outcomes.…”
Section: Scenario 1: Pedestrian Struck By Motor Vehicle – Highlightinmentioning
confidence: 99%