Shared Decision-Making for the Promotion of Patient-Centered Imaging in the Emergency Department: Suspected Kidney Stones - PROJECT SUMMARY
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, and result in over a million ED visits each year. Total charges for the care for kidney stones exceed $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
stakeholders to facilitate a conversation aimed to enable Shared Decision-Making. Dr. Schoenfeld proposes to:
(Aim 1) use established stakeholder engagement methods, including interviews and focus groups, to develop,
design, and revise a decision aid to use in the setting of suspected renal colic, and (Aim 2) pilot this decision
aid via a randomized controlled trial of 100 ED patients presenting with signs and symptoms of suspected renal
colic. The overall goals of this project are to educate and empower patients to be involved in medical decisions
that involve radiation exposure, and to safely decrease the radiation burden to this population. Both Aims will
be carried out at Baystate Medical Center, Springfield, MA, which serves a population with a large proportion of
minority and low-income patients (AHRQ priority populations). The data from the pilot will support the
development of a larger randomized controlled trial aimed at increasing SDM in the ED and safely decreasing
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
overall research goals are to make ED care safer, more patient-centered, and more cost-effective.
