Challenges in the Literature Around Context-Sensitive Implementation of Shared Decision Making in Emergency Medicine: A Scoping Review.

Background: Shared decision making is a healthcare method in which health personnel and patients collaboratively evaluate different management options for medical decisions. Despite possible restraints this method encounters in the context of emergency medicine, there is a growing body of evidence. This article critically appraises the current literature and challenges to inform future research efforts.

Methods: This scoping review respects the PRISMA- and PECOS-methodologies. Qualitative- and quantitative studies were included when exposing emergency health personnel or patients to collaborative care for medical decisions with multiple reasonable management options. PubMed, CENTRAL, APA PsycINFO, Web of Science, reference lists and research group remarks served as data sources. Three researchers handled title- and abstract screening; one researcher extracted and synthesized data. Basic data on study design, publication date, country of origin, estimates for time consumption and more were extracted through standardized forms for all publications. All outcomes from the randomized clinical trials were included and reported, following the authors' conclusions. This includes effects on consultation times. Through tabular visualization, critical appraisal and author group discussions, challenges in the literature were summarized narratively. Neither risk of bias assessment nor meta-analysis were performed.

Results: Of 3954 hits, 3428 remained for the title- and abstract screening and 67 for data synthesis. Studies predominantly utilized observational designs (n=27), originated from the USA (n=50) and were published between 2011 and 2020 (n=46). The included randomized trials (n=6) report heterogeneous results on patient-reported outcome measures and resource utilization. Patient safety was reported as not affected. In three randomized trials, consultations were prolonged by 2 minutes on average. Through critical appraisal and author group discussions, six annotations on the literature on shared decision making in emergency medicine were stipulated.

Conclusion: Research on shared decision making in emergency medicine utilizes different, intertwined terminologies, originates mostly from the USA and focuses on decision aids. The few randomized trials exclude high-risk patients and suggest potential resource-saving effects without compromising patient safety. The formal increase in discussion times appears debatable.