Patient Preferences Regarding Shared Decision Making in the Emergency Department: Findings From a Multisite Survey

Autor: Marc A. Probst, Nikita Nayyar, Hemal K. Kanzaria, Sarah H. Sabbagh, Elizabeth M. Schoenfeld, Denise D. Quigley, Peter St. Marie, Kyle Gress
Přispěvatelé: Hess, Erik P
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
Cross-sectional study
Decision Making
Clinical Sciences
Control (management)
MEDLINE
Sample (statistics)
Emergency Care
Article
7.3 Management and decision making
Hospital
03 medical and health sciences
0302 clinical medicine
Clinical Research
Surveys and Questionnaires
Behavioral and Social Science
Humans
Medicine
030212 general & internal medicine
Physician-Patient Relations
Emergency Service
business.industry
Patient Preference
030208 emergency & critical care medicine
General Medicine
Emergency department
Middle Aged
Health Services
Emergency & Critical Care Medicine
Patient preference
United States
Preference
Cross-Sectional Studies
Good Health and Well Being
Scale (social sciences)
Family medicine
Public Health and Health Services
Emergency Medicine
Female
Management of diseases and conditions
Patient Participation
Emergency Service
Hospital
business
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, vol 25, iss 10
ISSN: 1553-2712
1069-6563
DOI: 10.1111/acem.13499
Popis: Objectives As shared decision making (SDM) has received increased attention as a method to improve the patient-centeredness of emergency department (ED) care, we sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to SDM in the ED. Methods We surveyed a cross-sectional sample of adult ED patients at three academic medical centers across the United States. The survey included 32 items regarding patient involvement in medical decisions including a modified Control Preference Scale and questions about barriers and facilitators to SDM in the ED. Items were developed and refined based on prior literature and qualitative interviews with ED patients. Research assistants administered the survey in person. Results Of 797 patients approached, 661 (83%) agreed to participate. Participants were 52% female, 45% white, and 30% Hispanic. The majority of respondents (85%-92%, depending on decision type) expressed a desire for some degree of involvement in decision making in the ED, while 8% to 15% preferred to leave decision making to their physician alone. Ninety-eight percent wanted to be involved with decisions when "something serious is going on." The majority of patients (94%) indicated that self-efficacy was not a barrier to SDM in the ED. However, most patients (55%) reported a tendency to defer to the physician's decision making during an ED visit, with about half reporting they would wait for a physician to ask them to be involved. Conclusion We found that the majority of ED patients in our large, diverse sample wanted to be involved in medical decisions, especially in the case of a "serious" medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit. After fully explaining the consequences of a decision, clinicians should make an effort to explicitly ascertain patients' desired level of involvement in decision making.
Databáze: OpenAIRE
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