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271 Systematic review of barriers, facilitators and tools for shared decision-making in emergency departments
  1. Dirk T Ubbink1,2,
  2. Melissa Matthijssen2,
  3. Samia Lemrini2
  1. 1Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
  2. 2University of Amsterdam, Amsterdam, The Netherlands

Abstract

Introduction Implementing shared decision-making (SDM) in Emergency Departments (EDs) seems especially challenging, considering the fast-paced environment and sometimes life-threatening situations. Over ten years ago, a previous review revealed only few decision support tools (DSTs) available for EDs.1 We systematically reviewed all studies focusing on barriers, facilitators and tools currently available for SDM in EDs.

Methods Literature searches were conducted in MEDLINE, Embase and the Cochrane library, till November 2023. Observational and interventional studies were included if addressing barriers or facilitators for SDM or investigating effects of DSTs for patients visiting an ED. Study selection, risk of bias assessment, and data extraction were conducted by two investigators independently. Discrepancies were discussed with a third investigator. PROSPERO registration-ID: CRD42023473858.

Results We screened 1,537 studies for eligibility, of which 25 were retained. Barriers and facilitators were identified on three levels: 1) Patients: emotions, health literacy, and their own proactivity; 2) Clinicians: fear of medico-legal consequences, lack of SDM-skills or knowledge, and their ideas about treatment superiority; 3) System: time constraints, institutional guidelines, and availability of DSTs. DSTs studied in EDs were on chest pain, syncope, analgesics usage, lumbar puncture, ureterolithiasis, vascular access, concussion/brain bleed, head-CT choice, video-otoscopy, coaching for elderly people, and activation of patients with appendicitis. DST-effects were a significant increase in knowledge (9%), less decisional conflict (-13.6 points), and more patient satisfaction and engagement (25.4%).

Discussion Circumstances in EDs are generally less favourable for SDM. However, DSTs for conditions seen in EDs are helpful to overcome barriers against SDM and are welcomed by patients. Also, tools for physicians have become available to help them engage in SDM.2

Conclusion Even in EDs, SDM is feasible and supported by an increasing number of tools for patients and physicians.

References

  1. Flynn D, Knoedler MA, Hess EP, Murad MH, Erwin PJ, Montori VM, Thomson RG. Acad Emerg Med. 2012;19(8):959–67.

  2. Coronado-Vazquez V, Gomez-Salgado J, Cerezo-Espinosa de los Monteros J, Garcia-Colinas MA. J Emerg Nurs. 2019;45(4):386–93.

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