the right care shared decision making programme dr steven laitner gp and national clinical lead for...
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The Right Care Shared Decision Making Programme
Dr Steven LaitnerGP and National Clinical Lead for Shared Decision Making
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What is shared decision making?
Shared decision-making is a process in which patients are:
involved as active partners with their clinician
in clarifying acceptable medical options
and choosing a preferred course of clinical care.
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What are they sharing?
Clinicians Patients
• Experience of illness• Social circumstances• Attitude to risk• Values• Preferences
• Diagnosis• Cause of disease • Prognosis• Treatment options• Outcome probabilities
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Why?
%
Wanted more involvement in treatment decisions:
Source: NHS inpatient surveys
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Knee replacement satisfaction
• Satisfaction questions were completed by 8095 patients
• Overall- 81.8% were satisfied- 11.2% were unsure- 7.0% were not satisfied
• The OKS varied according to patient satisfaction (p<0.001)
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Variation in UK
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Hip Replacement
When analysed by PCT boundary, the variation in rates of expenditure for cemented primary hip replacement per 1000 population is 16-fold.
The rate of expenditure for uncemented primary hipreplacement per 1000 population also varies substantially among PCTs at greater than 30-fold
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Rate of anterior cruciate ligament reconstruction expenditure per 1000 population by PCT Weighted by age, sex, and need; 2008/09
The variation among PCTs in the rate of expenditure for anterior cruciate ligament reconstruction per 1000 population is 50-fold.
in Sweden, reported in the New England Journal of Medicine, where it was found that:
“a strategy of rehabilitation plus earlycruciate ligament repair was not superior to a strategy of rehabilitation plus optional delayed reconstruction. The latter strategy substantially reduced the frequency of surgical reconstructions”.1
1. Frobell RB et al. New England Journal of Medicine 2010: 363; 386-388.
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Top 30 PCTs(Lowest Rates)
Next 31 PCTs
Next 30 PCTs
Next 31 PCTs
Bottom 30 PCTs (Highest Rates)
Top 30 PCTs(Lowest Rates)
Next 31 PCTs
Next 30 PCTs
Next 31 PCTs
Bottom 30 PCTs (Highest Rates)
Top 30 PCTs(Lowest Rates)
Next 31 PCTs
Next 30 PCTs
Next 31 PCTs
Bottom 30 PCTs (Highest Rates)
London
Variation in knee replacement activity
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A New Paradigm for Demand Management?
Supporting individuals so that they may make rational health and medical decisions based on a consideration of benefits and risks (for them!)………
…and their values and preferences
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Decision Aids reduce rates of discretionary surgery
RR=0.76 (0.6, 0.9)
O’Connor et al., Cochrane Library, 2009
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The policy context
Commissioning for
Value
QIPP | Right Care RIGHT CARE FOR POPULATIONS
NHS Atlas of Variation
Population Planning and Programme Budgeting
Accountable Integrated Systems of Care
RIGHT CARE FOR PATIENTS
Shared Decision Making
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NHS Direct Patient Decision Aids
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Patient Comments:
"All the necessary information was there in simple illustrative manner"
“Easy to follow and explained in simply in plain English“
“I have an understanding of what I want to get across to the consultant”
"Own time, own space, own pace"
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Patient Decision Aids Phases 1 - 3
Phase Healthcare Decision Addressed by the Patient Decision Aid Current Status or Expected Launch Date
1 Osteoarthritis of the knee Rolled-out since February 2011
1 BPH Rolled-out since February 2011
1 Localised prostate cancer Rolled-out since February 2011
2 Breast cancer surgery choices Rolled-out since August 2011
2 Chorionic villus sampling/amniocentesis Rolled-out since August 2011
2 Prostate Specific Antigen (PSA) testing Rolled-out since August 2011
3 Osteoarthritis of the hip Rolled-out since August 2011
3 Cataract surgery Rolled-out since August 2011
3 Advanced kidney disease (end of life care plan) Autumn 2011 -launch date TBC
www.nhsdirect.nhs.uk/en/DecisionAids
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Patient Decision Aids To be developed over the next 24 months
Healthcare Decision Addressed by the Patient Decision Aid
• Abdominal aortic aneurysm screening and repair
• End stage renal failure
• Multiple sclerosis
• Serous otitis media
• Sciatica
• Chronic obstructive pulmonary disease (COPD)
• Stable angina
• Inguinal and umbilical hernia
• Cholecystitis acute or recurrent
• Non insulin dependent diabetes
• Carpal tunnel syndrome
• Menorrhagia/ menstrual disorders
• Recurrent tonsillitis
• End of life care
• Atrial fibrillation
• Obesity
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Key messages
• Patients want to be more involved in decisions about their healthcare
• Doctors and nurses need to work better with patients to share the decision-making process. This requires a culture change
• Decision aids and decision support help patients make healthcare decisions which are right for them and right for society
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Thank you
Give people the care they need and no less,
the care they want and no more
www.rightcare.nhs.uk