Shared decision making

Doctor and patient

Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.

Angela Coulter and Alf Collins in their recent Kings Fund report, ‘Making Shared-Decision Making a Reality‘ define shared decision making as;

‘a process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counseling and a system for recording and implementing patients’ informed preferences.’

In today’s health service there is an expectation that clinicians will work together with their patients to help them make choices about treatments, lifestyle, surgery and diagnostic tests. Patients and the public want to be involved more than they have ever been, and there is a strong desire for information and support to make decisions about their health and wellbeing. Coulter and Collins  make the point that there is also ‘compelling evidence that patients who are active participants in managing their health and health care have better outcomes than patients who are passive recipients of care.’

The principle of shared decision-making in the context of a clinical consultation is that it should:

    • support patients to articulate their understanding of their condition and of what they hope treatment (or self-management support) will achieve
    • inform patients about their condition, about the treatment or support options available, and about the benefits and risks of each
    • ensure that patients and clinicians arrive at a decision based on mutual understanding of this information
    • record and implement the decision reached.
Doctor and patient talking

Patients who are active participants in managing their health and health care have better outcomes than patients who are passive recipients of care

SDM honours both the provider’s expert knowledge and the patient’s right to be fully informed of all care options and the potential harms and benefits. This process provides patients with the support they need to make the best individualized care decisions, while allowing providers to feel confident in the care they prescribe.

The recent White Paper ‘Equity and Excellence: Liberating the NHS’ published in July 2010 states ‘We will put patients at the heart of the NHS, through an information revolution and greater choice and control: Shared decision-making will become the norm: no decision about me without me.’ The Government goes further in the White paper, saying ‘Patients will have access to the information they want, to make choices about their care.’ It is now acknowledged that the provision of high quality, evidence based information is a foundation of shared decision making and without it, choice and genuine partnership between the individual and their health professional is not possible.

Shared decision making also features in the Department of Health’s Information Strategy 2012;

“The case for embedding shared decision-making throughout NHS practice has been strongly made. Not only is there a strong ethical imperative driving the case for us to be partners in our own care, but evidence shows that involving us in making important decisions about our own lifestyle or treatment options improves our experience of care and the quality of our lives. Research shows strong proven benefits for us as patients from shared decision-making, including:

    • better treatment adherence – we stick to our treatment plans;
    • we have improved confidence and coping skills;
    • fewer of us choose major surgery, creating cost savings;
    • our health behaviours improve, such as increasing exercise and reducing smoking; and
    • we use services more appropriately, particularly with fewer emergency admissions.

Decision Aids are tools designed to help patients make difficult decisions about their treatments and medical tests. They present evidence based estimates of the benefits and risks of treatment and are used when there is no clinical evidence to suggest that one treatment is better than another. Decision aids are tailored to a patients’ individual health and help them to make specific, personal choices about their treatment. The support the decision making process between an individual and their clinician. They are available in various formats such as leaflets, interactive media, video/DVD or audio tape.

Key Points

  1. Thumbs-upShared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.
  2. The provision of high quality, evidence based information is a foundation of shared decision making and without it, choice and genuine partnership between the individual and their health professional is not possible.
  3. Shared decision making is now seen as an essential component of patient centred care and is a growing and increasingly significant part of health policy and NHS services, particularly in England.
  4. Decision aids are tools designed to support shared decision making, for patients to use with their health professionals to make important decisions about treatment and care. There is a growing range of decision aids available to support decision making in medicines taking, surgical procedures and treatments. A number of organisations now offer decision aids or are in the process of developing them.
Acknowledgement: Sarah Smith, PiF
Page last updated: 9/10/12