AEM Early Access 40: Shared Decision Making in Patients With Suspected Uncomplicated Ureterolithiasis: A Decision Aid Development Study

Welcome to the fortieth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to a recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

DISCUSSING (OPEN ACCESS THROUGH July 31; CLICK ON TITLE TO ACCESS)

Shared Decision Making in Patients With Suspected Uncomplicated Ureterolithiasis: A Decision Aid Development Study. Elizabeth M. Schoenfeld MD, MS, Connor Houghton DO, Pooja M. Patel DO, Leanora W. Merwin DO, Kye P. Poronsky MA, Anna L. Caroll, Carol Sánchez Santana, Maggie Breslin, Charles D. Scales MD, MSHS, Peter K. Lindenauer MD, MSc, Kathleen M. Mazor EdD, Erik P. Hess MD, MS

LINK TO THE PDF OF THE SHARED DECISION AID AVAILABLE HERE:
https://drive.google.com/open?id=1zWJN4kRO3WRma2Jcq_U2QxRmdmA5ucBr

LISTEN NOW: INTERVIEW WITH FIRST AUTHOR DR. SCHOENFELD

Elizabeth M. Schoenfeld MD, MS

Department of Emergency Medicine

Institute for Healthcare Delivery and Population Science

UMASS Medical School - Baystate

Adjunct Faculty, Tufts School of Medicine

Twitter: @EMSchoenfeld

ABSTRACT:

Objective

The objective was to develop a decision aid (DA) to facilitate shared decision making (SDM) around whether to obtain computed tomography (CT) imaging in patients presenting to the emergency department (ED) with suspected uncomplicated ureterolithiasis.

Methods

We used evidence‐based DA development methods, including qualitative methods and iterative stakeholder engagement, to develop and refine a DA. Guided by the Ottawa Decision Support Framework, International Patient Decision Aid Standards (IPDAS), and a steering committee made up of stakeholders, we conducted interviews and focus groups with a purposive sample of patients, community members, emergency clinicians, and other stakeholders. We used an iterative process to code the transcripts and identify themes. We beta‐tested the DA with patient–clinician dyads facing the decision in real time.

Results

From August 2018 to August 2019, we engaged 102 participants in the design and iterative refinement of a DA focused on diagnostic options for patients with suspected ureterolithiasis. Forty‐six were ED patients, community members, or patients with ureterolithiasis, and the remaining were emergency clinicians (doctors, residents, advanced practitioners), researchers, urologists, nurses, or other physicians. Patients and clinicians identified several key decisional needs including an understanding of accuracy, uncertainty, radiation exposure/cancer risk, and clear return precautions. Patients and community members identified facilitators to SDM, such as a checklist of signs and symptoms. Many stakeholders, including both patients and ED clinicians, expressed a strong pro‐CT bias. A six‐page DA was developed, iteratively refined, and beta‐tested.

Conclusions

Using stakeholder engagement and qualitative inquiry, we developed an evidence‐based DA to facilitate SDM around the question of CT scan utilization in patients with suspected uncomplicated ureterolithiasis. Future research will test the efficacy of the DA in facilitating SDM.