title: Shared Decision-making in the Emergency Department: Respecting Patient Autonomy When Seconds Count.
abstract: Shared decision-making (SDM), a collaborative process in which patients and providers make health care 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. Despite these challenges, in a recent survey emergency physicians reported there to be more than one reasonable management option for over 50% of their patients and that they take an SDM approach in 58% of such patients. SDM has also been selected as the topic on which to develop a future research agenda at the 2016 Academic Emergency Medicine consensus conference, "Shared Decision-making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda" (http://www.saem.org/annual-meeting/education/2016-aem-consensus-conference). In this paper the authors describe the conceptual model of SDM as originally conceived by Charles and Gafni and highlight aspects of the model relevant to the practice of emergency medicine. In addition, through the use of vignettes from the authors' clinical practices, the applicability of SDM to contemporary EM practice is illustrated and the ethical and pragmatic implications of taking an SDM approach are explored. It is hoped that this document will be read in advance of the 2016 Academic Emergency Medicine consensus conference, to facilitate group discussions at the conference.
authors.affiliation: The Department of Emergency Medicine, the Knowledge and Evaluation Research Unit, the Division of Healthcare Policy Research, Department of Health Services Research, and the Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Hess
authors.affiliation: The Departments of Emergency Medicine and Population Health, New York University, New York, NY.
authors.forename: Corita R
authors.initials: CR
authors.lastname: Grudzen
authors.affiliation: The Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Thomson
authors.affiliation: The Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: The Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Carpenter
mesh_terms: D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000941:ethics / Q000458:organization & administration*; D006801:Humans; D010358:Patient Participation; D026684:Personal Autonomy; D057766:Policy; D013997:Time Factors