Shared Decision Making in Patients With Suspected Uncomplicated Ureterolithiasis: A Decision Aid Development Study

Area of Science:

• Emergency Medicine
• Medical Decision Making
• Health Informatics

Background:

• Ureterolithiasis (kidney stones) diagnosis in the emergency department (ED) often involves computed tomography (CT) scans.
• Shared decision making (SDM) is crucial for patient-centered care, especially when diagnostic tests have risks like radiation exposure.
• Developing effective decision aids (DAs) requires understanding patient and clinician perspectives.

Purpose of the Study:

• To develop and refine an evidence-based decision aid (DA) for SDM regarding CT scan use in suspected uncomplicated ureterolithiasis.
• To incorporate patient and clinician input throughout the DA development process.
• To ensure the DA addresses key decisional needs and facilitates informed choices.

Main Methods:

• Utilized qualitative methods, including interviews and focus groups with diverse stakeholders (patients, clinicians, community members).
• Applied iterative refinement and beta-testing with patient-clinician dyads in real-time ED settings.
• Guided by established frameworks like the Ottawa Decision Support Framework and International Patient Decision Aid Standards (IPDAS).

Main Results:

• Engaged 102 participants in the DA design and refinement process.
• Identified key decisional needs: accuracy, uncertainty, radiation exposure/cancer risk, and return precautions.
• Developed and beta-tested a six-page DA, noting a prevalent pro-CT bias among some stakeholders.

Conclusions:

• An evidence-based DA was successfully developed through extensive stakeholder engagement and qualitative inquiry.
• The DA aims to facilitate SDM concerning CT scan utilization for ureterolithiasis.
• Future research is planned to evaluate the DA's effectiveness in promoting SDM.