Shared Decision Making to Improve Goals of Care in the ED

Develop a shared decision making (SDM) intervention informed by insights elicited from patients and clinicians to improve goals of care discussions.

The process of decision aid design involves: (1) review and synthesis of the evidence; (2) an analysis of usual practice through observation of clinical encounters; (3) development of an initial decision aid prototype; (4) field testing in the context of clinical care to gain insights on both intended and unintended effects of its use in practice to facilitate patient centered goals of care discussions; and (5) successive iterations of the decision aid until thematic saturation is reached and it is ready for testing in a clinical trial.

Inclusion:

• Patients presenting to Mayo Clinic Rochester, Saint Marys' Emergency Department,
• Patients at high risk for critical illness as determined by an Elderly Risk Assessment (ERA) score ≥ 16 or as determined by provider discretion,
• ≥ 60 years of age,
• Ability to provide informed consent,
• Medically stable at the time of enrollment,
• Able to participate without causing a delay in care.

Exclusion:

• GCS scores < 15,
• Signs of altered mental status,
• Known to be pregnant,
• Incarcerated or in Police Custody,
• Communication barriers such as visual or hearing impairment that may preclude use of the decision aid.