Attitudes and Practices of Shared Decision Making Regarding CT Scan Testing for Abdominal Pain in the Emergency Department

Background: Computerized tomography (CT) imaging is commonly ordered in the emergency department (ED). However, the utility of shared decision making (SDM) has not been studied in this context. This study assessed the attitude of patients and providers toward SDM regarding the decision to perform a CT scan in ED patients with abdominal pain; evaluated how SDM is utilized when CT testing is likely to be considered; and determined the association between SDM and CT usage. Methods: As part of a prospective observational study, ED patients with abdominal pain in whom a CT scan was likely to be considered a diagnostic option were screened. Hemodynamically-stable adult patients who met the inclusion criteria were approached for participation. For each patient and provider, a baseline preference for SDM using the Control Preferences Scale was established. The patient-provider encounter was then observed and assessed for how providers discussed the option of ordering a CT scan. These encounters were scored using the OPTION5 tool. Descriptive statistical analyses examining the association between preference for SDM and its in discussions were conducted using the chi-square test or Fisher’s exact test. Results: Twenty-nine encounters were observed in the ED. CT was considered in 70% of encounters; in 55% of encounters, a CT scan was ordered. 60% of patients and providers reported that they preferred to share responsibility with each other when deciding treatment plans. In direct observation, all providers made no effort or minimal effort to discuss options regarding the decision to perform a CT scan. There was no association between SDM practice and CT utilization. Conclusions: High rates of provider and patient preference to perform SDM for diagnostic management plans were reported but minimal to no effort was observed regarding the use of CT scan for ED patients with abdominal pain