A Shared Decision Making Implementation Group has started to develop a Tayside approach to shared decision. This group will provide high level leadership to support teams to develop and access tools and resources that encourage shared decision making before, during and after appointments. This is going to be an ongoing process within NHS Tayside, including patient awareness and staff education.
There are several drivers for shared decision making:
Cochrane Review 2017 - Improves knowledge f condition, improves accuracy of risk perception and reduces decisional conflict.
Kings Fund 2012 - Evidence that doctors do not accurately predict patient values. Evidence that a shared decision leads to reduced demand and fewer procedures.
Medicolegal (Montgomery) 2015 - Law now requires a doctor to 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.
Our Voice Citizen's Jury on Shared Decision Making 2019 - Highlights the public's enthusiasm for this to become a fundamental part of their care experience.
There are some published methods of how to implement shared decision making in practice such as The Health Foundation The MAGIC Programme and NICE Guidance on Shared Decision Making.
Key Elements for Implementation
Organisational Commitment - High level leadership including executive and patient level leaders, programme management to develop, support and share, plus organisational wide promotion of shared decision making.
Training - NES accredited training, action learning sets, tailored approach, techniques and tools to be used prior, during and after consultation.
Team Engagement - Team bases champions connected and supported, peer support and training on appropriate methods and appreciative approach to engaging teams.
Toolkits - Option Grids, Decisional Conflict Scale, Brief Decision Aids, tools to measure the impact of SDM, decision quality measures and questionnaires.
Shared Decision Making in Tayside
The First Steps in Shared Decision Making
Patients should feel able to ask questions of their team and the BRAN questions help by providing them with simple questions that could be asked in any setting. The “It’s Okay to Ask” campaign emphasises these questions and they can also be viewed in the waiting room on Near Me consultations. These can also be viewed on the Choosing Wisely UK website in a variety of different formats.
What Does Shared Decision Making Mean?
Shared Decision Making applies to all clinical members of staff not just medical staff. It recognises that, during a consultation in any setting, there are two experts in the room: the clinician, who has knowledge of published guidance and experience of seeing similar conditions in the past, and the patient who is an expert in their individual preference regarding treatments and risks. By encouraging patients to ask about the Benefits, Risk, Alternatives and impact of doing Nothing we can share and agree plans more effectively. Discussing tests, management and treatment plans in this way helps a patient understand the risk and benefits of each option so they are more informed about their care.
Informing patients about their options and treatment represents good practice from a medicolegal perspective and is required in guidance from professional bodies such as the GMC,NMC etc. Therefore most clinicians in every setting will already be attempting to practice in this way. It is important that we learn from good practice, provide training to those clinicians who need it and provide access to tools that might help before, during or after a consultation. It is also important to empower and encourage patients to ask questions. By having these conversations in a structured way, and explaining risk and benefits minimises the risk of misunderstanding throughout this time. Shared Decision Making should provide time is to allow a patient to express their feelings, expectations, and explore risks.
A treatment courses that is deemed for one patient, may not necessarily suit the next patient in the same way. Every patient will have different preferences.
Informing patients about their options and treatment represents good practice from a medicolegal perspective and is required in guidance from professional bodies such as the GMC,NMC etc. Therefore most clinicians in every setting will already be attempting to practice in this way. It is important that we learn from good practice, provide training to those clinicians who need it and provide access to tools that might help before, during or after a consultation. It is also important to empower and encourage patients to ask questions. By having these conversations in a structured way, and explaining risk and benefits minimises the risk of misunderstanding throughout this time. Shared Decision Making should provide time is to allow a patient to express their feelings, expectations, and explore risks.
A treatment courses that is deemed for one patient, may not necessarily suit the next patient in the same way. Every patient will have different preferences.
