title: Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study.
abstract: OBJECTIVE
  The objective was to describe perceptions of practicing emergency physicians (EPs) regarding the appropriateness and medicolegal implications of using shared decision-making (SDM) in the emergency department (ED).
  
  
  METHODS
  We conducted a cross-sectional survey of EPs at a large, national professional meeting to assess perceived appropriateness of SDM for different categories of ED management (e.g., diagnostic testing, treatment, disposition) and in common clinical scenarios (e.g., low-risk chest pain, syncope, minor head injury). A 21-item survey instrument was iteratively developed through review by content experts, cognitive testing, and pilot testing. Descriptive and multivariate analyses were conducted.
  
  
  RESULTS
  We approached 737 EPs; 709 (96%) completed the survey. Two-thirds (67.8%) of respondents were male; 51% practiced in an academic setting and 44% in the community. Of the seven management decision categories presented, SDM was reported to be most frequently appropriate for deciding on invasive procedures (71.5%), computed tomography (CT) scanning (56.7%), and post-ED disposition (56.3%). Among the specific clinical scenarios, use of thrombolytics for acute ischemic stroke was felt to be most frequently appropriate for SDM (83.4%), followed by lumbar puncture to rule out subarachnoid hemorrhage (73.8%) and CT head for pediatric minor head injury (69.9%). Most EPs (66.8%) felt that using and documenting SDM would decrease their medicolegal risk while a minority (14.2%) felt that it would increase their risk.
  
  
  CONCLUSIONS
  Acceptance of SDM among EPs appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective.
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Probst
authors.affiliation: The Department of Emergency Medicine, University of California at San Francisco, San Francisco General Hospital, San Francisco, CA.
authors.forename: Hemal K
authors.initials: HK
authors.lastname: Kanzaria
authors.affiliation: The Patient Care Program, Gordon and Betty Moore Foundation, Palo Alto, CA.|The Department of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
authors.affiliation: The Department of Emergency Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Hess
authors.affiliation: The Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Gary
authors.initials: G
authors.lastname: Winkel
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ka Ming
authors.initials: KM
authors.lastname: Ngai
authors.affiliation: The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Lynne D
authors.initials: LD
authors.lastname: Richardson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D019937:Diagnostic Techniques and Procedures; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D010465:Perception; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires