CANDIDATE: Dr. Elizabeth Schoenfeld is an Emergency Medicine Physician at the University of Massachusetts Medical School ? Baystate. She completed a fellowship in Emergency Ultrasound and a Masters in Clinical and Translational Science, and her goal is to become an independent investigator with expertise in Shared Decision-Making (SDM), decision aid development, and clinical trials of SDM in the Emergency Department (ED), with a focus on the diagnosis and management of acute renal colic (kidney stones) in ED patients. RESEARCH PROJECT: Kidney stones affect 1 in 11 Americans, cause debilitating pain,andresultinoveramillionEDvisitseachyear.Totalchargesforthecareforkidneystonesexceed$10 billion annually. The large majority of patients seen in an ED for a possible kidney stone undergo a CT scan, despite strong evidence that an ultrasound is safe, effective, less expensive, and does not expose patients to radiation. Because there are potential risks and benefits to both CT and ultrasound, the decision regarding which to use is an appropriate one for Shared Decision-Making, the ?collaborative process in which patients and physicians make a health care decision together, taking into account the best available evidence and the patient?s values and preferences.? Decision aids are tools designed by clinicians, patients, and other stakeholderstofacilitateaconversationaimedtoenableSharedDecision-Making.Dr.Schoenfeldproposesto:
(Aim1) useestablishedstakeholderengagementmethods,includinginterviewsandfocusgroups,todevelop, design, and revise a decision aid to use in the setting of suspected renal colic, and (Aim 2) pilot this decision aidviaarandomizedcontrolledtrialof100EDpatientspresentingwithsignsandsymptomsofsuspectedrenal colic.Theoverallgoalsofthisprojectaretoeducateandempowerpatientstobeinvolvedinmedicaldecisions that involve radiation exposure, and to safely decrease the radiation burden to this population.
Both Aims will becarriedoutatBaystateMedicalCenter,Springfield,MA,whichservesapopulationwithalargeproportionof minority and low-income patients (AHRQ priority populations). The data from the pilot will support the developmentofalargerrandomizedcontrolledtrialaimedatincreasingSDMintheEDandsafelydecreasing CT use. ENVIRONMENT AND MENTORS: Under the experienced mentorship of Drs. Lindenauer, Mazor, Hess, and Pekow, Dr. Schoenfeld will carry out the proposed research plan in concert with a structured curriculum focusing on qualitative methods, clinical trials, and patient-oriented research methods. Dr. Schoenfeld?s proposal brings together the resources of the Baystate Medical Center Emergency Department (which sees 115,000 patients/year), the Institute for Healthcare Delivery and Population Science (UMMS- Baystate), the University of Massachusetts Medical School Center for Clinical and Translational Science, and the Tufts Clinical and Translational Science Institute. In alignment with AHRQ?s mission, Dr. Schoenfeld?s overallresearchgoalsaretomakeEDcaresafer,morepatient-centered,andmorecost-effective.
/PUBLICHEALTHRELEVANCE AlthoughaCTscanisrequiredforsomeEmergencyDepartmentpatientswithsignsandsymptomsofakidney stone,recentevidencehasshownthatroutinescanningisunnecessaryandmayexposeyoungpatientsto significantcumulativeradiation,increasingtheirriskoffuturecancers.SharedDecision-Makingmayfacilitate diagnosticimagingdecisionsthataremoreinlinewithpatients?valuesandpreferences.Bycomparinga sharedapproachtodiagnosticdecision-makingtoatraditional,physician-directedapproach,thispilotstudy laysthefoundationforafuturerandomizedtrialthatwillreduceradiationexposure,improveengagement,and improvethequalityandpatient-centerednessofEmergencyDepartmentcare.