CME – Shared Decision Making: Perceptions of Emergency Physicians

CME – Shared Decision Making: Perceptions of Emergency Physicians
Author Information (click to view)

Hemal K. Kanzaria, MD, MS

Assistant Professor of Clinical Emergency Medicine
University of California, San Francisco School of Medicine

Hemal K. Kanzaria, MD, MSHPM, has indicated to Physician’s Weekly that his work on this study was supported by the VA Office of Academic Affiliations through the VA/Robert Wood Johnson Foundation Clinical Scholars program.

Figure 1 (click to view)
Figure 2 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:


  1. Discuss the findings of a survey of emergency physicians on the frequency with which shared decision making may be appropriate in their clinical practice as well as the implications of these findings.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at

Credit Available(click to view)


CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.


AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)


Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Hemal K. Kanzaria, MD, MS
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.


Hemal K. Kanzaria, MD, MS (click to view)

Hemal K. Kanzaria, MD, MS

Assistant Professor of Clinical Emergency Medicine
University of California, San Francisco School of Medicine

Hemal K. Kanzaria, MD, MSHPM, has indicated to Physician’s Weekly that his work on this study was supported by the VA Office of Academic Affiliations through the VA/Robert Wood Johnson Foundation Clinical Scholars program.

Shared decision making (SDM) could be an important step toward providing patient-centered, high-value care in the ED if it becomes more widespread. However, many emergency physicians perceive patient-related barriers that must be overcome in order to better utilize SDM in the ED setting.
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Shared decision making (SDM) involves physicians and patients collaboratively discussing potential management strategies when there is more than one reasonable treatment option to consider. Together, decisions are reached based on the available evidence and patient preference. “SDM can enhance patient knowledge and satisfaction and help ensure that medical decisions are closely aligned with patients’ values,” explains Hemal K. Kanzaria, MD, MS.

It can be challenging to integrate SDM into ED care because of its fast-paced environment. In addition, EDs must manage high-acuity patients and there are varying levels of treatment uncertainty throughout emergency medicine (EM). For example, EPs may face pressure to make rapid decisions to increase throughput. Some ED patients may also be unable to seek decision-making help from family, friends, and trusted individuals. Furthermore, patients may express that they want their clinicians take a more dominant role in decision-making when the stakes are high.

Studies analyzing SDM in EM have shown that this approach appears to be feasible and that many of these challenges can be overcome. “Greater efforts are being made to achieve patient-centered care with SDM, but few studies have examined the viewpoints of frontline EM physicians,” says Dr. Kanzaria. “A better understanding of the perceptions of EPs on this topic is critical to increasing adoption of SDM in EM.”

Surveying Emergency Physicians

In a study published in Academic Emergency Medicine, Dr. Kanzaria and colleagues surveyed EPs on the frequency with which SDM may be appropriate in their clinical practice. The authors also examined perceptions on the potential for SDM to reduce medically unnecessary diagnostic testing, the barriers to employing SDM in the ED, and the association between perceived barriers to SDM and self-reported use of it. “Surveyed EPs believed that there were multiple reasonable management options in over 50% of their patients,” says Dr. Kanzaria. “This suggests there is great opportunity for integrating SDM in emergency care.”

EPs endorsed SDM as a promising solution to reduce over-testing, according to the study, but many respondents perceived that patients often prefer to have their physicians make decisions (Table 1). “EPs also believed that—when offered a choice—patients may opt for more aggressive care than is actually needed,” Dr. Kanzaria says. “Others indicated that it would be too complicated for patients to know how to choose. The main perceived barriers to engaging patients were patient-related.”

The study also revealed that EPs who more strongly endorsed barriers to SDM were less likely to report personally using it in their own practice. For example, physicians who “agreed” or “strongly agreed” with the statement that “many patients prefer doctors to decide what to do” reported less use of SDM in their own practice when compared with EPs who “disagreed” or “strongly disagreed” with the statement. This relationship between endorsement of a barrier and decreased use of SDM was also true for other barrier statements (Table 2).

Analyzing the Implications

Recently, a call to action has been issued in EM to provide high-value, cost-conscious care. This initiative also endorses the use of SDM tools. As such, Dr. Kanzaria says it is important to understand the beliefs of EPs on the barriers they face to achieving this goal. “It would be inappropriate to promote SDM primarily as a cost-saving measure,” he says. “However, SDM should be viewed as a helpful approach to ensure that patients have an opportunity to choose care that is most suitable for them when reasonable options exist.”

Although it is encouraging that many EPs feel they are engaging patients in a collaborative decision-making process, Dr. Kanzaria says there is room for improvement. The results of the study suggest that SDM is not universally practiced in a substantial number of patients in whom it would be appropriate. “Ultimately, our goal should be to engage all patients in their care, to the degree that they wish, given the appropriate clinical situation,” Dr. Kanzaria says.

More studies are needed to explore the extent and manner to which ED patients want to be involved in emergency care decisions, according to Dr. Kanzaria. “Both physicians and patients should be aware of the potential value of SDM,” he says. “There also needs to be a cultural shift within medicine to facilitate true patient engagement. It should be routine to ask patients if and how they want to be involved in their healthcare decisions.”



Readings & Resources (click to view)

Kanzaria HK, Brook RH, Probst MA, Harris D, Berry SH, Hoffman JR. Emergency physician perceptions of shared decision-making. Acad Emerg Med. 2015;22:399-405.

Kanzaria HK, Hoffman JR, Probst MA, Caloyeras JP, Berry SH, Brook RH. Emergency physician perceptions of medically unnecessary advanced diagnostic imaging. Acad Emerg Med. 2015;22:390-398.

Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27:1361-1367.

Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368:6-8.

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