Patrick Archambault: Wiki Head CT Choice study: adaptation of two decision aids to support shared decision making about performing a head CT for adult and pediatric victims of mild traumatic brain injury : an update

Introduction: Mild traumatic brain injury (mTBI) is among the most common neurological conditions in Canada. Head computed tomography (CT) scans are used as the reference standard test to rule out life-threatening complications, but present potential exposition risks for the patient. Despite the use of clinical decision rules (Canadian Head CT Rule; Pediatric Head Injury/Trauma Algorithm (PECARN)), head CTs remain overused in Emergency Departments (EDs). Two decision aids (DAs) (pediatric and adult) developed in the United States (U.S.) may help reduce the use of CTs for mTBI.
Objective: To adapt these two DAs developed in the U.S. to the Québec context using the user-centered design. These DAs were originally designed to provide clinicians with tools to support shared decision making (SDM) about the use of head CTs.
Four out of six phases of the study were fully or partially completed. (1) A consensus meeting with SDM experts, decision makers and patient representatives was organized using the Nominal Group Technique. The original DAs were translated in French and adaptations were integrated into the tools. (2) Ethnographic observation of interactions between emergency health professionals and mTBI patients were made to qualitatively understand the needs of patients, family members and health professionals and to create the first design adaptation of the tools. (3) We organized consultation meetings with physicians from two EDs and project collaborators to gather comments on the tools (n≈40). (4) We are now completing the interviews of 5 mTBI patients and 5 parents of mTBI patients to gather their opinions on the tools. The tools will be redesigned based on the feedback. (5) Usability testing will be done using a think aloud method in 5 real-life clinical encounters in the ED and final modifications will be made to the tools design. (6) The final phase will involve the development of training and implementation of the tool.
Results: Improvements to the tools have been suggested. According to physicians and experts, we should make the design clearer and more user-friendly, take into consideration the contexts where the tools will be used and the clinical situations when they will be used. Moreover, not all hospitals need DAs and not all situations are appropriate to use them and information provided in our tools must be consistent with other health organizations. The patients (and parents) also suggested more user-friendly and simple tools and different times when the tools could be used. Patients also identified the importance of including caregivers while discussing performing CT scans with the tools since it might be difficult for the mTBI patient to fully understand and make decisions in the ED. Contrary to most physicians’ beliefs, patients expressed that the tools could control anxiety. Moreover, most patients didn’t know about shared decision making prior to the study. Our research highlighted the need to train health professionals on how to use the tools and to inform the patient on the process of SDM. It identifies the necessity to take into consideration the opinion of the different stakeholders when developing tools.