BACKGROUND. There is evidence of overuse of computed tomography (CT scan) in victims of mild traumatic brain injury (mTBI) for which about 10-35 % of scans are done inappropriately. In prescribing a brain CT scan for patients who do not show signs or symptoms of serious injuries, physicians are unnecessarily exposing patients to ionizing radiation that can increase their risk of developing cancer during their lifetime. One factor for this overuse is social pressure exerted by patients. Shared decision making (SDM) can decrease the overuse of resources. There exists two shared decision aids (DAs) (children and adult) developed in the United States to reduce the use of CT scans for mTBI.
OBJECTIVES. We have three goals: 1) Translate two DAs for the use of CT scans for mTBI (pediatric and adult) developed in the United States and adapt them to the Québec context; 2) Create a training program on the adoption of SDM in EDs to inform the decision to conduct a CT scan for mTBI; 3) Determine the CT scan rate (overuse, underuse or appropriate use) in two settings.
METHODS. Phase I: Translate the American DAs on the use of CT scans for mTBI (pediatric and adult) into French. We will then adapt the translated DAs to the local context of three hospitals: CHU Ste-Justine (version for children), Hôpital de l’Enfant-Jésus (version for adults) and Hôtel-Dieu de Lévis (two versions). We will employ user-centered design to perform rapid prototyping with mTBI patients. Before our first round of prototyping, we conducted a consensus meeting based on a Nominal Group Technique with patient partners and clinical experts to identify mandatory adaptations to the two American DAs.To better inform the design of our first prototype, we conducted ethnographic observation in one ED (Hôtel-Dieu de Lévis) to collect further comments and identify needed modifications. Individual interviews with mTBI victims will be held in order to collect their point of view about the tool’s design. Our final round of prototyping will involve 10 ED physicians-patient dyads using our DA in a real clinical encounter. Phase II: Develop training on SDM and the DAs (in class and online versions) for ED physicians and nurses based on our observations from the Phase I. Phase III: Retrospective chart analysis will be done in two settings to determine the rate of CT scan use before the implementation of the tool.
PRELIMINARY RESULTS: Our consensus meeting and ethnographic observations helped design our first prototypes and adapt the original American DAs to our context in Québec. Participants at the consensus meeting identified that risk communication had to be improved and wording had to be clearer. Participants also mentioned that it was unclear what population should be targeted with the DAs. Feedback from ED physicians on our first prototype highlight potential information overload, literacy issues and potential increase in patient anxiety. Further interviews with patients will help us validate these findings to make sure that our prototype is well adapted for use with ED patients.