What is Shared Decision Making?
Shared decision-making is a joint process in which a healthcare professional works together with a person to reach a decision about their care.
It involves choosing tests and treatments based both on evidence and on what matters to the person, their individual goals, preferences, beliefs and values.
It makes sure the person understands the risks, benefits and possible consequences of different options through discussion and information sharing (Shared decision making | NICE guidelines).
The conversation brings together:
- The healthcare professionals expertise, such as treatment options, evidence, risks and benefits.
- What matters to the person, their preferences, personal circumstances, goals, values and beliefs.
Why is it important?
Shared decision making is a one of the six approaches of the NHSE universal personalised care model as outlined in the shared decision-making summary guide. It is intrinsic in Professional Codes of Conduct and Standards, the General Medical Council, 2020, the Nursing and Midwifery Council, 2018 and Health and Care Professions Council, 2018. Research tells us that People want to be more involved than they currently are in making decisions about their own health and health care, that both individuals and clinicians tend to consistently over-estimate the benefits of treatments and under-estimate the harms (Hoffman, 2017). It has the potential to enhance efficiency and reduce unwarranted clinical variation (Mulley et al, 2012).
The Montgomery Case-The Royal College of Physicians and Surgeons of Glasgow
Shared decision making | NICE guidelines
GMC shared decision making professional standards
Care Quality Commission Inpatient Survey, 2020
NHS England shared decision making summary guide
This summary guide is aimed at people leading local implementation of shared decision
making (SDM). It enables:
- increased understanding of what good SDM looks like and how it ensures that we commission and provide systems and services that informed individuals want
- commissioning of local SDM initiatives and embedding them in care pathways
- providers to have better conversations with people using services, thereby supporting them to make more informed choices based on their personal values and preferences and what is known of the risks, benefits and consequences of the options available to them.
The summary guide provides an implementation framework stating that 4 key areas need to be in place to embed SDM:
NHSE shared decision-making summary guide
The implementation checklist below is a practical tool to help you start or continue conversations to understand where you are locally on SDM and to support local improvements.
Prepared Public – It’s Ok to Ask
The Patient Information Forum (PIF) and the Patients Association worked with NHS Nottingham and Nottinghamshire Integrated Care Board (ICB) to look at ways of making it easier for patients to take part in shared decision-making.
Together we delivered a co-production programme with the My Life Choices panel of local people and the NHS Nottingham and Nottinghamshire personalised care team.
Removing Barriers to Shared Decision-Making provides the key learnings and outcomes from the project.
The system adopted the recommendations and use It’s ok to ask to prepare the public for a shared decision-making conversation.
It’s ok to ask resource pack
| Document | Link to document | Key messaging |
| SDM BRAN Communication Tool | Healthcare professionals BRAN Communication Tool | |
| It’s Ok to Ask webpage | It’s ok to ask | |
| It’s ok to ask film | It’s Ok to Ask film | |
| It’ OK to Ask banners | ||
| Its OK to Ask strap lines | ||
| It’s OK to Ask appointment letter insert | ||
| About Me | About Me form | |
| About Me easy read | About Me easy read version form | |
| About Me guidance | How to complete an About Me | |
Trained teams
An online learning resource to embed shared decision-making
Resources you can use
Why should I prioritise Shared Decision Making, I only have very short amount of time to see patients?
Whilst it may take a little longer to have initial conversation in a more personalised way, shared decision making ensures that individuals are supported to make decisions that are right for them, which in the longer term means fewer follow up queries and overall it makes the whole patient pathway more efficient.
Why do we need this, I am approachable?
Our patients do not always feel empowered to ask as there is a knowledge and power dynamic. Shared decision making conversations can support people to be able to feel more confident to make choices that are right for them. Consistent feedback is that people do not always feel viewed as a partner in their healthcare, more as a passive recipient.
How is this relevant to my practice?
Most of our interactions involve treatment of some kind, and consenting to treatment requires first understanding what matters most to a patient, as outlined in the GMC guidance. Shared decision making supports people to be able to tell you what matters to them to guide your professional advice and options in an individualised way to get to the right outcome.
Will a Shared Decision Making approach take longer?
Encouraging people to come with questions and write down what matters to them before they come to a consultation will help to make things more efficient as the groundwork of thinking about what matters to them has been completed.
Will this mean that people can demand certain treatments?
The law is clear that whilst patients have the right to ask questions and make decisions about what care meets their needs based on the benefits, risks, alternative and ‘do nothing’ options, it is up to the professional to describe what options would be suitable treatments.
