Validation of the shared decision-making model in the context of a patient presenting to the emergency department with chest pain of possible cardiac origin.

Abstract

The intention of this thesis was to investigate the feasibility of clinical shared decision-making. If physicians are to contribute to a shared decision process, they will need to be able to communicate unbiased information to their patients clearly. Thus, physicians need to provide some form of quantitative risk estimate. Physicians estimated the probability that a patient presenting with chest pain had Acute Coronary Syndrome. The patients details were then entered into a structured clinical risk calculator and the results were compared. It was found that although both methods held comparable predictive power, the physician’s estimate did not correlate well with the structured estimate. This suggests that physicians do not utilise a quantitative risk estimate. It then found that the correlation between risk estimates increased as further investigations were performed. However, neither estimation method could predict these test results. It was hypothesised that physicians utilise a dichotomous decision process. Thus, as positive and negative test results erode the intermediate risk group and populate the high and low risk groups, the correlation between methods increases. It was concluded that a dichotomous decision process would provide a considerable hurdle to the shared decision-making process, as it would limit the communicability of the physicians thought process. However, the potential benefits of shared decision-making encourage future researchers to find a way to overcome this hurdle