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Adapting two American Decision Aids for Mild Traumatic Brain Injury to the Canadian Context Using the Nominal Group
El Kebir Ghandour1,2, Lania Lelaidier Hould3, Félix-Antoine Fortier3
1Institut National d'excellence en Santé et en Services Sociaux (INESSS), 2535, Boulevard Laurier, 5e étage, Québec, QC, G1V 4M3, Canada. elkebir.ghandour@inesss.qc.ca.
The Patient
|October 20, 2020
Summary
Canadian experts adapted American decision aids for head computed tomography (CT) scans in mild traumatic brain injury cases. Modifications ensure cultural relevance and improved patient understanding of CT scan risks and benefits.
Area of Science:
- Medical Decision Making
- Emergency Medicine
- Neuroscience
Background:
- Decision aids can decrease unnecessary head computed tomography (CT) scans.
- Overuse of head CT scans is a significant concern in managing mild traumatic brain injury (mTBI).
Purpose of the Study:
- To achieve expert consensus in Canada on adapting American decision aids for head CT use in adult and pediatric mild traumatic brain injury (mTBI).
- To tailor existing decision support tools to the Canadian healthcare, social, cultural, and legal context.
Main Methods:
- A Nominal Group Technique consensus meeting was conducted with 21 Canadian stakeholders and the original authors of the American decision aids.
- Data were collected through various methods including videotaping, written materials, and online collaborative tools.
- Proposed modifications were analyzed using qualitative thematic content analysis.
Main Results:
- A total of 84 ideas were generated, focusing on clarifying the decision aids' purpose, problem, and target population.
- Key adaptations include sociocultural adjustments, better target user identification, and improved descriptions of head CT utility, advantages, and risks.
- Participants emphasized refining the representation of brain injury and head CT risks, and incorporating locally adapted patient follow-up plans.
Conclusions:
- The Nominal Group Technique successfully identified necessary adaptations for American head CT decision aids for Canadian mTBI patients.
- Adaptations focus on user targeting, information content, and communication of benefits and risks within Canada's unique context.
- Future research will involve prototyping, formative evaluations, and impact assessment on CT scan utilization.
