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- Title
The Physician-as-Stakeholder: An Exploratory Qualitative Analysis of Physicians' Motivations for Using Shared Decision Making in the Emergency Department.
- Authors
Schoenfeld, Elizabeth M.; Goff, Sarah L.; Elia, Tala R.; Khordipour, Errel R.; Poronsky, Kye E.; Nault, Kelly A.; Lindenauer, Peter K.; Mazor, Kathleen M.; Pines, Jesse
- Abstract
Background Shared decision making ( SDM) is increasingly recognized as an important facet of patient-centered care. Despite growing interest in SDM in the emergency department ( ED), little is known about emergency physicians' ( EPs') motivations for using SDM. Understanding current patterns of SDM use and EP's rationale for using SDM is essential for the development of interventions to increase use. Objectives Recognizing the EP as an important stakeholder in SDM research, we sought to identify and explore factors that may motivate EPs' engagement in SDM. Methods In this qualitative study, informed by the Theory of Planned Behavior and Social Cognitive Theory, we conducted semistructured interviews with a purposeful sample of EPs. Interviews were recorded and transcribed verbatim. Using a directed qualitative content analysis approach, three members of the research team performed open coding of the transcripts in an iterative process, building a provisional code book as coding progressed. Respondent validation was employed to ensure methodologic rigor. Results Fifteen EPs, ages 31-65, from both academic and community practice settings, were interviewed. Several had not heard of the specific phrase 'shared decision making,' but all understood the concept and felt that they used SDM techniques to some degree. Most noted they had often had an agenda when they used SDM, which often motivated them to have the conversation. Agendas described included counteracting an algorithmic or defensive approach to diagnosis and treatment, avoiding harmful tests, or sharing uncertainty. All participants believed that patients benefited from SDM in terms of satisfaction, engagement, or education. Nearly all participants identified research outcomes that they felt would encourage their use of SDM (e.g., improvements in patient engagement, mitigation of risk) and many prioritized patient-centered outcomes over systems outcomes such as improved resource utilization. Little consensus was seen, however, regarding the importance of individual outcomes: of eight potential research outcomes participants endorsed, no single outcome was endorsed by even half of the physicians interviewed. Conclusion Emergency physicians identified many factors that motivated them to use SDM. This study informs current research on SDM in the ED, particularly regarding the motivations of the physician-as-stakeholder.
- Subjects
MEDICAL practice; BEHAVIOR; COMMUNITIES; CONCEPTUAL structures; EMERGENCY medicine; EMERGENCY physicians; ETHNIC groups; HOSPITAL emergency services; INTERVIEWING; MOTIVATION (Psychology); PHYSICIANS; RACE; DECISION making in clinical medicine; QUALITATIVE research; DATA analysis; SOCIAL learning theory; ACQUISITION of data; PATIENT-centered care
- Publication
Academic Emergency Medicine, 2016, Vol 23, Issue 12, p1417
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/acem.13043