When health professionals and patients collaborate in emergency departments: a qualitative chart review

Background: In shared decision making, health professionals and patients collaborate inevaluating different available management options for medical decisions. Apart from single trials on medical conditions like nontraumatic chest pain, more extensive projects implementing shared decision making in emergency medicine are absent. Among numerous implementation barriers, the concept of clinical equipoise appears blurry and arbitrary, demanding an equidistance between available management options. Consequently, this article aims to inform future implementation projects for shared decision making in emergency departments and update the concept of clinical equipoise. Methods: Following the Standards for Reporting Qualitative Research (SRQR) and an interpretive approach, retrospective data were extracted from 366 medical cases within a German emergency department. Two raters assessed the feasibility of the medical decisions in those patients towards the perceived feasibility for shared decision making. Afterward, results were thematically grouped. Results: Factors related to patients, health professionals and the healthcare context contributed to feasibility. Furthermore, three repeating situations were identified as potentially feasible for shared decision making in emergency departments: (a) stable patients holding unclear risks of deterioration, (b) patients in which different yet justifiable treatment options exist and (c) aligning patients’ health status with the extent of further medical actions. To increase trustworthiness in the underlying methodologies, a multidisciplinary research team was recruited, data transparency was ensured, and results were compared to existing evidence. Conclusions: Based on the results, this article extends the framework for shared decision making in emergency medicine and updates the concept of clinical equipoise. Due to its qualitative, interpretive and retrospective nature, our conclusions should undergo context-sensitive interpretation. The study was registered before conduction and its dataset is available in the Open Science Framework, DOI: 10.17605/OSF.IO/CYZ5G.

Patient participation; Communication; Ethics; Equipoise; Artificial intelligence; Implementation

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