Physicians' Perspectives Regarding the Use of Shared Decision-Making in the Emergency Department
Shared Decision-Making (SDM) is the "process in which clinicians and patients work
together to select tests, treatments, (and) management…based on clinical evidence
and the patient's informed preferences." It has been shown to inform and engage
patients, temper uncertainty, and in specific scenarios, to decrease utilization and
costs. Despite its potential to improve care, ... read morelittle is known about how and when SDM is
used in the Emergency Department (ED). Several studies have examined SDM interventions
in the ED, but very little stakeholder engagement has been published regarding this
practice. Stakeholder engagement for ED SDM interventions should include ED clinicians
("providers"), ED patients and family members, nurses, hospital administrators, and
payers. Because SDM is most frequently initiated by providers and not patients,
understanding providers' perspectives may represent the theoretical crux needed to
promote this patient-centered method of communication. Simply put, SDM will not occur if
the provider does not initiate it. Because little research exists regarding Emergency
Physicians (EPs) perspectives regarding SDM, we sought to explore attitudes towards SDM
(motivators, barriers, and facilitators) via qualitative inquiry. Via semi-structured
interviews with a purposeful sample of EPs, we investigated the use of SDM in the ED,
including the barriers to and facilitators of use, attitudes towards SDM, and
motivations of EPs when SDM is used. Our results demonstrated that while the name "SDM"
is new to some EPs, the practice of SDM is used by all providers to some extent.
Physicians recognized that SDM was good for patients - improving communication and
providing value-congruent care - but also that it was hard to do, and major barriers
exist. Concrete barriers, such as lack of reliable follow-up care, often prevented the
use of SDM. Emotional barriers also played a large role, such as the fear of a bad
outcome or litigation. Our research also exposed numerous reasons why residents are not
getting bedside training in SDM. In summary, our qualitative analyses provided an
in-depth exploration of providers' perspectives on the use of SDM in the ED, revealing
both actionable challenges and generating testable
Thesis (M.S.)--Tufts University, 2017.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Peter Lindenauer.
Committee: Penelope Pekow, and Farzad Newberry.
Keywords: Medicine, and Health sciences.read less