Elizabeth M Schoenfeld1,2, Marc A Probst3, Denise D Quigley4, Peter St Marie5, Nikita Nayyar6, Sarah H Sabbagh7, Tanesha Beckford8, Hemal K Kanzaria7. 1. Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA. 2. Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA. 3. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 4. RAND Corporation, Santa Monica, CA. 5. Office of Research and the Epidemiology/Biostatistics Research Core, University of Massachusetts Medical School-Baystate, Springfield, MA. 6. New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY. 7. Department of Emergency Medicine, University of California at San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA. 8. SUNY Upstate Medical University, Syracuse, NY.
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%). CONCLUSIONS: Fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.
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%). CONCLUSIONS: Fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.
Authors: Elizabeth M Schoenfeld; Shelby Mader; Connor Houghton; Robert Wenger; Marc A Probst; David A Schoenfeld; Peter K Lindenauer; Kathleen M Mazor Journal: Ann Emerg Med Date: 2019-01-03 Impact factor: 5.721
Authors: Hemal K Kanzaria; Robert H Brook; Marc A Probst; Dustin Harris; Sandra H Berry; Jerome R Hoffman Journal: Acad Emerg Med Date: 2015-03-23 Impact factor: 3.451
Authors: Elizabeth M Schoenfeld; Hemal K Kanzaria; Denise D Quigley; Peter St Marie; Nikita Nayyar; Sarah H Sabbagh; Kyle L Gress; Marc A Probst Journal: Acad Emerg Med Date: 2018-07-19 Impact factor: 3.451
Authors: Elizabeth M Schoenfeld; Sarah L Goff; Tala R Elia; Errel R Khordipour; Kye E Poronsky; Kelly A Nault; Peter K Lindenauer; Kathleen M Mazor Journal: Acad Emerg Med Date: 2016-11-25 Impact factor: 3.451
Authors: Erik P Hess; Judd E Hollander; Jason T Schaffer; Jeffrey A Kline; Carlos A Torres; Deborah B Diercks; Russell Jones; Kelly P Owen; Zachary F Meisel; Michel Demers; Annie Leblanc; Nilay D Shah; Jonathan Inselman; Jeph Herrin; Ana Castaneda-Guarderas; Victor M Montori Journal: BMJ Date: 2016-12-05