Patient Preference to Participate in Shared Decision Making for Performing a CT Scan in the Emergency Department

Patient Preference to Participate in Shared Decision Making for Performing a CT Scan in the Emergency Department Hamza Ijaz, BS, Chloe Michel, BS, Paige E Kulie, MPH, Lorna M Richards, MS, MFT, Andrew C Meltzer MD, MS1 1Department of Emergency Medicine, George Washington University Background: CT scans are widely used in US emergency departments and represent a major source of carcinogenic radiation.1 Shared Decision Making (SDM) is the principle of including the patient in the decision process regarding diagnostic and therapeutic options. SDM has been used successfully in decisions such as hospital admissions for chest pain and surgery for appendicitis.2,3 It is unknown if shared decision making is beneficial in the decision to order a CT scan in the ED. Our objective was to assess the desire of ED patients to participate in the decision process regarding CT scan use and describe differences in patients who want to participate versus those who do not want to participate. Methods: Patients who were receiving a CT scan in a tertiary care urban ED were approached from June to August 2016 and asked to participate in the study. If verbally consented, subjects were interviewed in the ED by a research assistant blinded to the objectives of the study after a CT scan had been ordered but prior to ED disposition. Results: Of the 102 subjects who were enrolled, 58% were female, the median age was 46.5, and 48% received an abdominal CT scan. 48% of all patients desired to “participate fully in the decision to perform CT scan,” compared to 44% who “did not want to participate in the decision to perform CT.” Of those who wanted to participate fully, there was no difference in median age, sex, type of CT, discussion of risks by physician, or explanation of alternatives by physician. Patients who wanted full participation were more likely to have concerns about CT scans (23% versus 11%, p=0.02) but also felt more involved in the decision process (31% versus 20%, p=0.04.) Conclusion: Approximately 50% of ED patients want to participate in the decision to perform a CT scan and among those patients, they are more likely to have concerns about CT scans. There was no increase in discussion of risks or alternatives for patients who wanted to participate in the decision. References 1. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357:2277-2284. 2. Kindermann DR, McCarthy ML, Ding R, et al. Emergency department variation in utilization and diagnostic yield of advanced radiography in diagnosis of pulmonary embolus. J Emerg Med. 2014;46:791-799. 3. Hess EP, Marin J, Mills A. Medically unnecessary advanced diagnostic imaging and shared decision-making in the emergency department: Opportunities for future research. Acad Emerg Med. 2015;22:475-477