Shared Decision Making in the ED: A tale of two studies
Author: Fernanda Bellolio, MD (@mfbellolio)
Shared decision-making (SDM), a collaborative process in which patients and providers make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient's values and preferences, is being increasingly advocated as the optimal approach to decision-making for many health care decisions. The rapidly paced and often chaotic environment of the emergency department (ED), however, is a unique clinical setting that offers many practical and contextual challenges. [reference: Hess EP et al. Academic Emergency Medicine, 2015, volume 22, issue 7, pages 856-864]
Our long-term goal is to promote evidence-based patient-centered approach and evaluation in the acute setting to more closely tailor testing to disease risk, reduce unnecessary diagnostic testing, and improve patient engagement in healthcare decisions in the Emergency Department.
The Chest Pain Choice Trial
Erik P. Hess, M.D., and our team are evaluating the utility of a decision aid in patient engagement and rates of cardiac stress testing for patients with chest pain in the emergency department.
This PCORI funded study had the objectives of testing if Chest Pain Choice improves patient-centered outcomes and decreased health care utilization in four diverse hospital EDs, taking into account patient values, preferences, and circumstances.
To accomplish this objective, we compared Chest Pain Choice to usual clinical care using risk stratification tools and a decision aid to:
- Test if Chest Pain Choice safely improves validated patient-centered outcome measures in a pragmatic parallel patient randomized trial. With the hypothesis that the intervention (Chest Pain Choice aid) will significantly increase patient knowledge, engagement, and satisfaction with no increase in adverse events.
- Test if the decision aid has an effect on healthcare utilization within 30 days after enrollment. With the hypothesis that the intervention will significantly reduce the rate of hospital admission, rate of cardiac testing, and total healthcare utilization.
This study was completed this year, and the abstract was presented at the American College of Cardiology Scientific Session in Chicago, IL, April 2016.
We found that the use of the decision aid increases patient knowledge, engagement and satisfaction without increase in adverse events. Hospital admissions, cardiac testing and health care utilization may also be reduced.
http://shareddecisions.mayoclinic.org/decision-aid-information/chest-pain-choice-decision-aid/
Trial registration: NCT01969240.
Head CT choice
We are evaluating the utility of a decision aid in patient and parent engagement and rates of head CT imaging for children with head trauma in the emergency department.
This PCORI funded ongoing study aims to:
- Give parents a voice and incorporate the perspectives of multiple stakeholders by refining the Head CT Choice decision aid.
- Test if the decision aid improves validated patient-centered outcome measures and safely decreases healthcare utilization, including: increase parents’ knowledge, engagement, and satisfaction; decrease the rate of head CT; and decrease 30-day total healthcare utilization with no increase in adverse events.
This is a multicenter clinician-level parallel randomized trial that compares an intervention group receiving a structured risk assessment and corresponding decision aid (Head CT Choice) to a control group receiving usual care.
This study is still enrolling, and it very close to completion.
https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-15-253
Trial Registration: NCT02063087
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