Acknowledgements
First and foremost, I am very grateful to my supervisor, Dr. Kerstin de Wit, for her mentorship and guidance throughout my time as a graduate student. It has been a pleasure to work with someone so innovative and passionate about clinical research. Her ability to bridge thrombosis and emergency medicine research to improve and change clinical practice is inspiring.
I am grateful to my supervisory committee members, Dr. Teresa Chan, Dr. Lori-Ann Linkins, and Dr. Mathew Mercuri, for their continuous support throughout this process. Our scientific discussions were always insightful, and motivated me to push myself as a researcher.
I am very thankful to the entire EMeRGE Research Group for creating such a helpful and friendly environment. Their diligence and commitment to conducting high-quality research motivated me to do the same, and greatly expanded my knowledge on clinical research. Working with this team made my experience as a graduate student very memorable.
I would like to thank my family and friends for all of the support they gave me throughout this entire process. Their constant encouragement and emotional support helped me overcome challenges and persevere, for which I am infinitely grateful. / Background: There is an evidence-practice gap between guidelines for diagnosing pulmonary embolism (PE) and emergency physician practice. This is concerning because computed tomography (CT) scanning is being overused to exclude PE in the emergency department (ED). It is possible that the answer behind this lies within the physician-patient relationship. Past research on shared decision-making strategies have shown to decrease use of hospital resources, and improve patient outcomes.
Objective: The aim of this three-part MSc thesis was to achieve a patient-centered approach to the testing of PE in the ED.
Method: 1) A systematic review on existing shared decision-making models used for testing and/or treatment of medical decisions in the ED was conducted. 2) Qualitative interviews with ED patients being tested for PE identified patient-specific values and preferences which may present as barriers to patient-centered care in the ED. 3) Both the systematic review and patient interviews informed the development of a new shared information tool to be used in the ED.
Results: The systematic review found that shared decision-making interventions in ED patients tested for acute coronary syndrome and clinically-important traumatic brain injuries can potentially reduce hospital admissions and increase discharge rates without negatively affecting health outcomes. The qualitative interviews highlighted four major themes: 1) patient satisfaction comes from addressing their primary concern; 2) preference for imaging over clinical examination; 3) patients expect 100% certainty when given a diagnosis; and 4) patients expect individualized care throughout their entire ED visit. This data led to the formation of a shared information sheet which ensures that testing decisions for low-risk PE patients align with patient-specific values.
Conclusion: By placing the focus on patient-centered care, this study incorporates evidence-based medicine with patient priorities in order to improve patient outcomes in the ED. / Thesis / Master of Science (MSc) / Pulmonary embolism occurs when blood clots form in veins of the legs, and travel to the lungs, causing chest pain and shortness of breath. There are well-established, evidence-based guidelines on how to diagnose pulmonary embolism. Diagnostic tools such as the Wells score and D-dimer have been proven to be safe and effective in ruling out pulmonary embolism in low risk patients preventing the need for a CT scan. However, CT scans are still being overused to diagnose pulmonary embolism in low risk patients. Unnecessary testing in the emergency department (ED) exposes patients to the harms associated with CT scanning: such as increased risk of cancer, and diagnosing blood clots that are not actually there, resulting in unnecessary treatment. It is possible that the answer behind the over-testing of PE in the ED lies within the physician-patient relationship. This three-part study first reviewed all prior studies on shared decision-making strategies, which are techniques used to help physician align medical decisions with patient-specific values, in the ED. Second, we employed qualitative methods to identify patient-specific values and preferences on PE testing in the ED. Finally, both of these aims informed the development of a patient-centered shared information tool to overcome barriers to patient-centered care. Ultimately, the goal of this study is to achieve a patient-centered approach to the testing of pulmonary embolism in the ED.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/24874 |
| Date | January 2019 |
| Creators | Swarup, Vidushi |
| Contributors | de Wit, Kerstin, Linkins, Lori Ann, Chan, Teresa, Mercuri, Mathew, Medicine |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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