DESCRIPTION (provided by applicant): The objective of this study is to examine Emergency Department (ED) providers' perspectives regarding the use of Shared Decision-Making in their practice. Shared Decision-Making (SDM) is the collaborative process that allows patients/caregivers and their providers to make healthcare decisions together, and has gained increasing traction not only as an ethical imperative, but as a method that increases informed decision-making, decreases resource utilization, improves patient safety and the communication of risk, and encourages patient engagement and patient-centered care. Policy recommendations and patient-advocacy centered around the benefits of increased patient-engagement have been growing. Emergency Departments in the United States are the site of nearly 130 million patient encounters each year, but it is unclear to what extent Emergency Department (ED) providers are involving patients in decision-making, as there has been no research in this area to date. The primary objective of this study is to explore ED providers' attitudes regarding SDM in order to understand: 1. What are their general attitudes towards SDM, and when do they use it? 2. What are the barriers to using SDM in the ED? 3. What are the facilitators to using SDM in the ED? 4. Which clinical scenarios lend themselves to the use of SDM? The outcome of this study will be a qualitative analysis of the answers to these questions, and the creation of a questionnaire to assess these concepts in a larger and more representative group of ED care providers. To accomplish these objectives the investigative team will conduct semi-structured interviews with ED physicians from a diverse group of practice settings. Hypotheses regarding barriers and facilitators to using SDM in the ED will be generated through the qualitative analysis, and a questionnaire to test these hypotheses will be developed and cognitively tested. This R03 builds on the investigative team's extensive experience studying patient and provider attitudes and preferences. This study will contribute to our understanding of physicians' attitudes and at the same time will provide the foundation for future interventional studies, particularly those looking to improve implementation of SDM interventions. Finally, this study maps to AHRQ's mission of making health care safer, higher quality, more accessible, equitable, and affordable by seeking to understand and address the barriers to the implementation of SDM, which can directly affect these higher goals. Additionally, as many of the AHRQ's priority populations receive a disproportionate amount of care in the ED, this study has the potential to expand SDM to patients who have not yet seen its benefits, potentially improving care and outcomes.

PUBLIC HEALTH RELEVANCE: Emergency Departments (ED) in the US treat millions of patients per year. Shared decision-making (SDM) is a method of giving ED patients a voice in their own healthcare decisions. Improving the use of Shared Decision- Making in the ED has the potential to increase patient engagement, improve the communication of risk, enhance patient safety, and improve outcomes and quality of care. This study will measure ED physicians' perceived barriers and facilitators to SDM to ultimately identify how best to implement SDM in the ED.