Shared Decision-Making in Emergency Departments: Context Sensitivity Through Divergent Discourses

Area of Science:

• Health Informatics
• Patient-Centred Care
• Clinical Decision-Making

Background:

• Patient-centred care and shared clinical decision-making are international healthcare goals.
• The Emergency Department (ED) is a critical setting for initial shared decision-making.
• Effective health information technology (HIT) implementation requires understanding the ED context.

Purpose of the Study:

• To explore factors influencing shared clinical decision-making in Emergency Departments.
• To identify unanticipated factors affecting patient-centred care in the ED.
• To inform the context-sensitive implementation of HIT in Emergency care.

Main Methods:

• Qualitative exploration using purposive and convenience sampling.
• In-depth interviews with clinicians and patients across three Australian EDs.
• Identification of divergent discourses surrounding shared decision-making.

Main Results:

• Three distinct discourses regarding shared decision-making were identified.
• Unanticipated factors influencing patient-centred care emerged from the data.
• Understanding these discourses is vital for HIT implementation.

Conclusions:

• Context-specific factors significantly impact shared decision-making in the ED.
• HIT implementation must consider these identified discourses for success.
• This research provides insights for improving patient-centred care in Emergency settings.