Shared Decision Making
Presented by: Ruth Sephton
Date: 12.10.2013
Shared Decision Making
• CSP involvement
• Overview of Shared Decision Making
(SDM)
• Evidence of improved outcomes
• Implementation
Involvement
• National SDM Programme 2012
• Advancing Quality Alliance (AQuA)
responsible for providing training in SDM
through clinician education, e-learning and a
collaborative project
• AQuA contacted CSP for endorsement
• 5BP joined the SDM collaborative
• Implemented SDM across Musculoskeletal
Services 2012
Roll out
Nutrition
and
DieteticsPodiatry
Child and
Adolescent
Mental Health
Services
Intermediate
Care
Adult Mental
Health
Services
Useful Contacts
• Suzanne MackieEmail: [email protected]
• Norah FloodEmail: [email protected]
• Ruth SephtonEmail: [email protected]
Shared Decision Making
‘Shared decision making is a process in which
individual patients are involved as active partners with
their clinicians to clarify acceptable options and
choose their preferred course of care, one that is
ideally aligned with their values and preferences’.
NHS Confederation 2012
When should SDM be used?
• When there is more than one reasonable
course of action
• In this case the decision is said to be
“preference sensitive”
• Most health and healthcare decisions are
“preference sensitive”
What are you making decisions about?
About lifestyleAbout medication
adherence
About accessing services
About possible planned
interventions
Decisions
What is being shared?
Clinicians
• Diagnosis
• Cause of disease
• Lifestyle
influences
• Prognosis
• Treatment options
• Outcome
probabilities
Patients
• Experience of
illness
• Social
circumstances
• Attitude to risk
• Values
• Preferences
Information
You should provide reliable, balanced, evidence-based
information as part of the discussion you have in your
consultation.
There are also Decision Support Tools that can be
used throughout the stages of the SDM process;
1. Long forms – Patient Decision Aids (PDA‟s)
2. Short forms – option grids
3. Ask 3 questions – patient prompt leaflets
PDA‟s and Option Grids
Ask 3 questions leaflet
But…
• You do not need to use PDA‟s or
option grids to implement SDM
• It is about a cultural shift between
patients and practitioners
Why is SDM Needed?
• Patients want more involvement in
decisions about health care
• Improves patient experience and
clinical outcome
• Reduces unwarranted variation
• „Political‟ agenda
„No decision about me, without me‟
Patients want involvement in decisions
When asked whether they had been sufficiently
involved in decisions about their care, nearly half of
hospital inpatients and 30% of outpatients said they
were not involved as much as they wanted to be1.
A survey on patient involvement found that over 50%
of people wanted a model where doctors and patients
made joint decisions about treatment decision. It also
found that a higher proportion of younger people
preferred this model, suggesting greater demand in
the future for joint decision-making2.
Source: (1) National Patient Surveys, 2009, Care Quality Commission
Source: (2) A. Coulter in Shared Decision-Making in Health Care, Adrian Edwards and Glyn Elwyn, 2009, page 159-160
Improved Patient Experience and Clinical Outcome
http://www.nationalvoices.org.uk/sites/www.nationalvoices.org.uk/files/dh_shared_decis
ion_making_-_evidence_base_v2_6_0.pdf
The evidence
Improved
quality of
life
17% less
admissions
to hospital Decreased
readmission
rates
Improved
clinical
outcomesImproved
adherence
with
treatment
Improved
patient
experience
Reduced
complaints
• PDA‟s have been shown to reduce discretionary surgery rates by 25%
Source: O'Connor et al. Decision aids for patients facing health treatment or screening decisions (review). Cochrane
Library, 2009 volume 2.
Primary Knee Replacement - AgeSexNeeds standardised cost per 1000 population for PCTs
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151
PCT
Ag
eS
ex
Ne
ed
s s
tan
da
rdis
ed
co
st
(£
pe
r 1
00
0 p
op
ula
tio
n)
Musculoskeletal programme- variation in knee
replacement activity
Political Drivers
Commissioning Outcomes Framework (COF)
National Institute for Clinical Excellence
(NICE) CG 138
Quality Innovation Productivity and
Prevention (QIPP)
Commissioning for Quality and Innovation
(CQUIN)
NHS Standard Contract
Political Drivers
Putting Patients First. The NHS England
business plan for 2013/14 – 2015/16
80% of CCGs will be commissioning to support
patients‟ participation and decisions over their
own care or will have a plan to do so by
December 2013. This includes information and
support for self-management, personalised
care planning and shared decision making
within normal service planning and
commissioning.
Challenges
“Patient‟s
don‟t want to
be involved”
“We do it
already”
“It takes too
long”
Every service should ensure that…
…People are supported to make informed and
personally relevant decisions about managing
their own health and healthcare
Should I take that
pill today?
Am I going to
stick to that
exercise
regime? Do I really
want that
operation?
Take Home Messages
• SDM is easy to implement and improve skills
• Easy to produce evidence of implementation
• Review the resources on the following
slide/information sheet
Could you improve Shared Decision Making
in your clinical practice?
Where to find out more
• For more information regarding Shared
Decision Making, patient information, video
clips and the Train the Facilitator Resource
pack go to:
– http://www.advancingqualityalliance.nhs.uk/ab
out-shared-decision-making/
• To access the Patient Decision Aids
produced by Totally go to:
– http://sdm.rightcare.nhs.uk/
• To view downloadable Option Grids go to:
– http://www.optiongrid.co.uk/
