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

Abstract

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.

Figure 1

Screened, approached, and surveyed patients and reasons for exclusion and refusal *Participants were able to give multiple reasons for refusal

Figure 2

Responses to modified Control Preferences Scale (CPS) items. The CPS was asked regarding three scenarios: admission versus discharge (dark blue), treatment decisions (grey), and testing decisions (light blue)

Figure 3

Patient agreement concerning barriers and facilitators to Shared Decision-Making in the Emergency Department. Figure 3a. Domains not perceived as barriers by most respondents; Figure 3b. Domains perceived as barriers by some respondents; Figure 3c. Domains perceived as facilitators by most respondents.

Figure 3

Patient agreement concerning barriers and facilitators to Shared Decision-Making in the Emergency Department. Figure 3a. Domains not perceived as barriers by most respondents; Figure 3b. Domains perceived as barriers by some respondents; Figure 3c. Domains perceived as facilitators by most respondents.

Figure 3

Patient agreement concerning barriers and facilitators to Shared Decision-Making in the Emergency Department. Figure 3a. Domains not perceived as barriers by most respondents; Figure 3b. Domains perceived as barriers by some respondents; Figure 3c. Domains perceived as facilitators by most respondents.