TY - JOUR
T1 - Shared Decisionmaking in the Emergency Department
T2 - A Guiding Framework for Clinicians
AU - Probst, Marc A.
AU - Kanzaria, Hemal K.
AU - Schoenfeld, Elizabeth M.
AU - Menchine, Michael D.
AU - Breslin, Maggie
AU - Walsh, Cheryl
AU - Melnick, Edward R.
AU - Hess, Erik P.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Probst is supported by grant K23HL032052 from the National Institutes of Health/National Heart, Lung, and Blood Institute. Dr. Melnick is supported by grant K08HS021271 from the Agency for Healthcare Research and Quality. Dr. Schoenfeld is supported by grant R03HS024311 from the Agency for Healthcare Research and Quality. Dr. Hess is supported by contract 0876 from the Patient-Centered Outcomes Research Institute. Dr. Kanzaria has been a consultant for RAND Health and Castlight Health.
Publisher Copyright:
© 2017 American College of Emergency Physicians
PY - 2017/11
Y1 - 2017/11
N2 - Shared decisionmaking has been proposed as a method to promote active engagement of patients in emergency care decisions. Despite the recent attention shared decisionmaking has received in the emergency medicine community, including being the topic of the 2016 Academic Emergency Medicine Consensus Conference, misconceptions remain in regard to the precise meaning of the term, the process, and the conditions under which it is most likely to be valuable. With the help of a patient representative and an interaction designer, we developed a simple framework to illustrate how shared decisionmaking should be approached in clinical practice. We believe it should be the preferred or default approach to decisionmaking, except in clinical situations in which 3 factors interfere. These 3 factors are lack of clinical uncertainty or equipoise, patient decisionmaking ability, and time, all of which can render shared decisionmaking infeasible. Clinical equipoise refers to scenarios in which there are 2 or more medically reasonable management options. Patient decisionmaking ability refers to a patient's capacity and willingness to participate in his or her emergency care decisions. Time refers to the acuity of the clinical situation (which may require immediate action) and the time that the clinician has to devote to the shared decisionmaking conversation. In scenarios in which there is only one medically reasonable management option, informed consent is indicated, with compassionate persuasion used as appropriate. If time or patient capacity is lacking, physician-directed decisionmaking will occur. With this framework as the foundation, we discuss the process of shared decisionmaking and how it can be used in practice. Finally, we highlight 5 common misconceptions in regard to shared decisionmaking in the ED. With an improved understanding of shared decisionmaking, this approach should be used to facilitate the provision of high-quality, patient-centered emergency care.
AB - Shared decisionmaking has been proposed as a method to promote active engagement of patients in emergency care decisions. Despite the recent attention shared decisionmaking has received in the emergency medicine community, including being the topic of the 2016 Academic Emergency Medicine Consensus Conference, misconceptions remain in regard to the precise meaning of the term, the process, and the conditions under which it is most likely to be valuable. With the help of a patient representative and an interaction designer, we developed a simple framework to illustrate how shared decisionmaking should be approached in clinical practice. We believe it should be the preferred or default approach to decisionmaking, except in clinical situations in which 3 factors interfere. These 3 factors are lack of clinical uncertainty or equipoise, patient decisionmaking ability, and time, all of which can render shared decisionmaking infeasible. Clinical equipoise refers to scenarios in which there are 2 or more medically reasonable management options. Patient decisionmaking ability refers to a patient's capacity and willingness to participate in his or her emergency care decisions. Time refers to the acuity of the clinical situation (which may require immediate action) and the time that the clinician has to devote to the shared decisionmaking conversation. In scenarios in which there is only one medically reasonable management option, informed consent is indicated, with compassionate persuasion used as appropriate. If time or patient capacity is lacking, physician-directed decisionmaking will occur. With this framework as the foundation, we discuss the process of shared decisionmaking and how it can be used in practice. Finally, we highlight 5 common misconceptions in regard to shared decisionmaking in the ED. With an improved understanding of shared decisionmaking, this approach should be used to facilitate the provision of high-quality, patient-centered emergency care.
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U2 - 10.1016/j.annemergmed.2017.03.063
DO - 10.1016/j.annemergmed.2017.03.063
M3 - Article
C2 - 28559034
AN - SCOPUS:85019705168
VL - 70
SP - 688
EP - 695
JO - Journal of the American College of Emergency Physicians
JF - Journal of the American College of Emergency Physicians
SN - 0196-0644
IS - 5
ER -