Abstrakt

Shared decision-making (SDM) is becoming increasingly important in emergency departments, although time pressure, diagnostic uncertainty, and varying patient conditions can pose challenges. Its implementation promotes trust and patient-centered decisions and can yield both, medical and economic benefits. Even though barriers exist at the patient, practitioner, and system levels, the literature shows that SDM can be effective in acute settings when appropriate communication strategies, decision aids, and organizational frameworks are implemented.
Background: Shared decision-making (SDM) is a central component of patient-centered medicine and is becoming increasingly important in emergency situations. However, the special conditions of the emergency room – time pressure, incomplete diagnostics, and emotional stress on patients – can interfere with a structured decision-making process. At the same time, studies show that SDM is feasible in this context and can improve trust and the quality of care.
Methods: This review article summarizes the current evidence, challenges, and ethical aspects of SDM in acute and emergency clinical medicine. In addition, studies on implementation were included.
Results: Barriers to SDM in the emergency department primarily include time pressure, limited health literacy, language barriers, and organizational constraints such as lack of privacy. Nevertheless, studies show that SDM and patient decision aids (PtDAs) increase knowledge and satisfaction and, in individual cases, can reduce unnecessary diagnostics and admissions. Ethically, SDM is an expression of respect for autonomy, but it can create conflicts when patient wishes and medical indications diverge or resources are scarce. Within the clinical team, both moral burden and improvements in interprofessional communication can arise. Facilitating factors include clear communication structures, decision-making aids such as interpreters, and institutional support from the provider.
Conclusions: SDM is also useful and, in principle, feasible in the dynamic environment of acute and emergency clinical medicine. Broader implementation requires structured decision-making aids, adapted forms of communication, and additional evidence on health literacy.

Autoreninformation

Autoren

• M. Brauchle^{1, 2}
• K. Fuest³

Abteilungen

• ¹ Landeskrankenhaus Feldkirch, Pflegeschule Vorarlberg-Standort Feldkirch, Feldkirch, Österreich,
• ² PMU-Paracelsus Medizinische Privatuniversität, Salzburg, Österreich,
• ³ TUM-Universitätsklinikum rechts der Isar, Technische Universität München, München

Adresse

Priv. Doz. Dr. med. Kristina Fuest
Klinik für Anästhesiologie und Intensivmedizin
TUM Universitätsklinikum Rechts der Isar
Ismaninger Str. 22
81675 München
Email: [email protected]

Citation