What is Shared Decision Making?
Shared decision-making ensures that individuals are supported to make decisions that are right for them. It is a partnership conversation between a clinician and a patient to reach the best decision about their treatment.
The conversation brings together:
- The clinician’s expertise, such as treatment options, evidence, risks and benefits
- What matters to the patient: their preferences, personal circumstances, goals, values and beliefs.
Why is it important?
Shared decision making is a one of the six approaches of universal personalised care. It is important as:
- It is a legal requirement and healthcare professionals must take “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment and of any reasonable alternative or variant treatments”.
- It is intrinsic in Professional Codes of Conduct and Standards; General Medical Council, 2020; Nursing and Midwifery Council, 2018; Health and Care Professions Council, 2018.
- Shared Decision Making has a NICE guidance surrounding it’s use in day to day clinical practice; part of business as usual
- It creates a new relationship between individuals and professionals based on partnership Mulley et al, 2012.
- People want to be more involved than they currently are in making decisions about their own health and health care Care Quality Commission Inpatient Survey, 2020; GP Patient Survey, 2022.
- 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.
Resources
Removing barriers to shared decisions – https://pifonline.org.uk/download/file/977/
Decision Support Tools – https://www.personalisedcareinstitute.org.uk/dsts-2/
Virtual Patients Avatars – https://www.personalisedcareinstitute.org.uk/virtual-patients
The Health Literacy Place – https://www.healthliteracyplace.org.uk/why-health-literacy/
Training and education resources / Health Education England – https://www.e-lfh.org.uk/programmes/shared-decision-making/
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.
