PATIENT AND PROVIDER PERSPECTIVES ON SHARED DECISION-MAKING IN SYNCOPE: QUALITATIVE GROUNDWORK FOR DECISION-SUPPORT INTERVENTION DEVELOPMENT

Purpose: Little is known about how to engage emergency department (ED) patients presenting with syncope (i.e., brief loss of consciousness) in shared decision-making. We sought input from key stakeholders to inform the development of a decision-support intervention for this condition. 

Method:

We conducted semi-structured interviews of adult patients presenting with syncope (n=10) and ED physicians and nurses (n=10) at an urban ED.  Interviews with syncope patients consisted of 9 open-ended questions eliciting their perceptions of what medical decisions, if any, were made during their ED visit and to what extent they felt involved. Patients were also asked what information they would like to have and how it should be presented to best engage them in their healthcare decisions. Interviews with providers consisted of 10 open-ended questions pertaining to the clinical management of syncope, factors influencing the decision to admit patients to the hospital, and the appropriateness of shared decision-making for this clinical scenario. All interviews were audio-recorded.  Patients were offered a $20 gift card for participating. 

Result:

Patients were not consistently aware that any medical decisions had been made during their ED visit. However, most patients stated a desire to be involved in their medical decisions. Patients expressed a preference for a verbal explanation from their physician as a means of obtaining information but were amenable to paper-based graphs or diagrams as well. Providers reported that patient age, past medical history and presence of a serious ED diagnosis were key factors influencing the decision to admit a patient with syncope. Most providers felt that shared decision-making could be appropriate for patients for whom they were in equipoise about admission, assuming the patient was unimpaired and possessed the health literacy to understand the potential benefits and harms of their options. Most providers expressed openness to the use of a decision-support intervention if it was evidenced-based and easy to use. 

Conclusion:

Both ED patients and providers appear to be agreeable to the use of shared decision-making to improve the disposition decision of syncope patients in select, appropriate cases.  Strategies to help clinicians engage patients with lower health literacy may be needed. The data collected in this study will be used to guide the development of a paper-based decision-support intervention for ED patients presenting with syncope.