Practices and attitudes towards radiation risk disclosure for computed tomography: survey of emergency medicine residency program directors.
OBJECTIVE
The purposes of this study were to evaluate the frequency with which emergency physicians involved in residency leadership disclose potential malignancy risks from computed tomography (CT), assess comfort with these discussions, and evaluate factors influencing risk disclosure.


METHODS
We surveyed emergency medicine residency program directors and associate/assistant directors. Primary outcome was the proportion who "almost always" or "most of the time" discussed potential risks.


RESULTS
Two hundred and seventy-four (50.6%) of 542 eligible physicians responded. There were 82.1% (95% CI 76.8%, 86.6%) who reported almost always or most of the time discussing potential risks for patients ≤18 years; proportions for adults 19-40, 41-65, and >65 years were 50.6% (95% CI 44.4, 56.7%), 20.7% (95% CI 16.0, 26.0%), and 5.2% (95% CI 2.9, 8.5%), respectively (test for trend, p < 0.001). The proportion reporting being "extremely" or "very" comfortable discussing risks was 57.1% (95% CI 51.1, 63.2%). Patient/family CT request that the physician felt was not indicated was of "very high" or "high" importance for driving risk discussions in 86.4% of respondents. For 75.5%, patient/family query about radiation risks was of "high" or "very high" importance. Among 57.4% of respondents, the patient being elderly and/or having a reduced life expectancy was of "high" or "very high" importance in the decision not to discuss risk.


CONCLUSIONS
Emergency physicians involved in residency leadership report frequently disclosing potential malignancy risks from CT at frequencies inversely proportional to patient age. About half are comfortable with discussions, and many discussions are driven by patient requests. Opportunities exist to optimize and standardize emergency department CT radiation risk disclosure practices.
Departments of Pediatrics and Emergency Medicine, University of Pittsburgh School of Medicine, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA, 15224, USA. jennifer.marin@chp.edu.
Jennifer R
JR
Marin
Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Karen E
KE
Thomas
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Angela M
AM
Mills
Division of Emergency Medicine, Duke University Medical Center, Box 3096, Durham, NC, 27710, USA.
Joshua S
JS
Broder
Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
Kathy
K
Boutis
D000367:Age Factors; D002170:Canada; D030881:Disclosure; D004503:Education, Medical, Graduate; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D006801:Humans; D007396:Internship and Residency; D007857:Leadership; D010817:Physician-Patient Relations; D000069079:Radiation Exposure / Q000009:adverse effects*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*; D014481:United States
Computed tomography; Consent; Disclosure; Emergency department; Radiation risk