Patient preferences for testing for pulmonary embolism in the ED using a shared decision-making model

Area of Science:

• Emergency Medicine
• Diagnostic Imaging
• Clinical Decision-Making

Background:

• Shared decision making (SDM) facilitates patient-clinician collaboration on medical choices.
• Elevating the d-dimer threshold for pulmonary embolism (PE) may reduce imaging needs in low-risk patients.
• This study explored patient preferences for a modified PE diagnostic strategy.

Purpose of the Study:

• To assess patient willingness to defer imaging for PE using an elevated d-dimer cutoff.
• To evaluate the role of SDM in diagnostic test selection for PE.

Main Methods:

• Prospective enrollment of emergency department patients with chest pain or dyspnea.
• Standardized information on PE diagnostic workup, including imaging risks and benefits of deferral, was provided.
• Patients surveyed on their preference to undergo or defer computed tomography of the pulmonary arteries (CTPA).

Main Results:

• 203 patients were enrolled; 37% chose to defer CTPA.
• Previous PE diagnosis was associated with a lower likelihood of deferring CTPA (P = .007).
• No significant association found between deferral and age, sex, family history, or risk-taking tendency.

Conclusions:

• A significant portion of patients are willing to defer PE imaging under specific low-risk conditions.
• SDM is an acceptable approach for patients regarding PE diagnostic strategies.
• This patient-centered approach may help reduce unnecessary imaging for PE.