Practices and attitudes towards radiation risk disclosure for computed tomography: survey of emergency medicine residency program directors.
Emerg Radiol. 2017 Mar 17. doi: 10.1007/s10140-017-1493-7. [Epub ahead of print] Marin JR1, Thomas KE2, Mills AM3, Broder JS4, Boutis K5.
PURPOSE: The purposes of this study were to evaluate the frequency with which emergency physicians involved in residency leadership disclose potential malignancy risks from computed tomography (CT), assess comfort with these discussions, and evaluate factors influencing risk disclosure.
METHODS: We surveyed emergency medicine residency program directors and associate/assistant directors. Primary outcome was the proportion who "almost always" or "most of the time" discussed potential risks.
RESULTS: Two hundred and seventy-four (50.6%) of 542 eligible physicians responded. There were 82.1% (95% CI 76.8%, 86.6%) who reported almost always or most of the time discussing potential risks for patients ≤18 years; proportions for adults 19-40, 41-65, and >65 years were 50.6% (95% CI 44.4, 56.7%), 20.7% (95% CI 16.0, 26.0%), and 5.2% (95% CI 2.9, 8.5%), respectively (test for trend, p < 0.001). The proportion reporting being "extremely" or "very" comfortable discussing risks was 57.1% (95% CI 51.1, 63.2%). Patient/family CT request that the physician felt was not indicated was of "very high" or "high" importance for driving risk discussions in 86.4% of respondents. For 75.5%, patient/family query about radiation risks was of "high" or "very high" importance. Among 57.4% of respondents, the patient being elderly and/or having a reduced life expectancy was of "high" or "very high" importance in the decision not to discuss risk.
CONCLUSIONS: Emergency physicians involved in residency leadership report frequently disclosing potential malignancy risks from CT at frequencies inversely proportional to patient age. About half are comfortable with discussions, and many discussions are driven by patient requests. Opportunities exist to optimize and standardize emergency department CT radiation risk disclosure practices.