Shared Decision Making for clinicians

Shared Decision Making Hub

Shared decision making highlights how the patient and their wishes should be at the centre of every decision throughout the perioperative pathway, the traditional option may not be desired or suitable for all patients. 

'Shared decision making is now a key concept for every aspect of perioperative care. There is a worldwide focus on this approach to treatment decisions, which is already a legal standard in the UK. One in three high-risk patients choosing surgery will experience serious medical complications leading to long-term decline in health and quality of life. Awareness of these long-term risks is poor among both doctors and patients. Consequently, many high-risk patients do not receive the information they need to make an informed decision about surgery.

Shared decision making is a collaborative process between clinicians and patients, which aims to select the most suitable treatment option based on both best available evidence and informed patient preferences.’

Read the full blog on Shared Decision Making and OSIRIS by Dr Ramai Santhirapala and Professor Rupert Pearse

Examples of Effective Shared Decision Making

Video one highlights what a standard consultation that does not support SDM would look like and video two below demonstrates an effective consultation where shared decision making is being used.

Between 2010 and 2013, the Health Foundation funded a UK programme in shared decision making called Making Good Decision in Collaboration (MAGIC). As part of the education and training component of MAGIC, these videos were produced which exemplify the steps of a high quality and suboptimal shared decision making consultation. These can be used as part of your educational programme in shared decision making.

E-Learning Specific to Perioperative Care

Here are open access- anyone from any professional background can create a login- 2 hour e-learning modules in shared decision making. They represent a collaboration between the Australian Commission on Safety and Quality in Health CareWinton Centre for Risk and Evidence Communication and the Academy of Medical Royal Colleges.

There are 6 specialties available, including perioperative care and have been updated in light of 2020 GMC informed consent guidance. You can read more about the initial evaluation of these modules here.

View the free open access learning here

Generic E-learning for Shared Decision Making

The Personalised Care Institute is a virtual organisation, accountable for setting the standards for evidence-based training in personalised care in England. Personalised care is a partnership approach that helps people make informed decisions and choices about their health and wellbeing, working alongside clinical information. 

Find out more about the resources and e-learning here

Developing a Workshop in Shared Decision Making

The following resources below provide trusts the opportunity to develop their own workshops in SDM to support staff where possible. The templates provided are examples that can be adapted and used as appropriate. 

Authors: Dr Anna Janowicz, Dr Ramai Santhirapala Consultant Anaesthetists, Guy’s and St Thomas’ NHS Foundation Trust

Please note permission from the authors has been provided to share these resources as a template.

No decision about me, without me.

Department of Health
Liberating the NHS Report, 2012

Resources for Effective Shared Decision Making

ChoosingWiselyUK

Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

Choosing Wisely UK is supported by the Academy of Medical Royal Colleges.

By having discussions that are informed by the doctor, but take into account what’s important to the patient too, both sides can be supported to make better decisions about care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.

The fantastic range of resources for doctors can be found here.

As part of Choosing Wisely UK pilot work at Guy's and St Thomas' NHS Foundation Trust, a patient leaflet was developed to support patients think through Benefits, Risks, Alternatives and doing Nothing. Please free to download it.

NICE

NICE have developed a Shared Decision Making learning package that contains over five different resources to support clinicians.

Find out more here 

NHSE
Clinical validation of surgical waiting lists: framework and support tools

In response to the increasing number of surgical patients on waiting lists due to the COVID-19 pandemic NHSE has developed resources to aid clinical decisions in the event of changed circumstances.

View the full set of resources here.

NHS Scotland
Right Decision

In response to Personalising Realistic Medicine: Chief Medical Officer for Scotland's Annual Report 2017-2018 NHS Scotland has developed 'The Right Decision' website that brings together all resources on SDM.

View all the available resources here .

Quality Improvement in Shared Decision Making

Read and download the Shared Decision Making in Perioperative Care chapter of the RCoA Quality Improvement Compendium. 

The guidance has been written by Dr Ramai Santhirapala and Professor Rupert Pearse.

Guidance for Effective Shared Decision Making

GMC
Decision Making and Consent

The GMC Guidance outlines the seven principles that all doctors must use to inform their interactions with patients. The guidance will support doctors to practise shared decision making and help their patients to make healthcare decisions that are right for them. 

Read the full guidance here.

NICE

NICE guideline [NG197] covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and people using services to work together to make decisions about treatment and care. It includes recommendations on training, communicating risks, benefits and consequences, using decision aids, and how to embed shared decision making in organisational culture and practices.

Read the guideline here

Realistic Medicine (Scotland)

One of the main aims of Realistic Medicine is for people using healthcare services and their families to feel empowered to discuss their treatment fully with healthcare professionals, including the possibility that a suggested treatment might come with side effects – or even negative outcomes.

Realistic Medicine is supported by a range of professional and patient organisations. They work closely with stakeholders such as the Royal Colleges, the Directors of Medical Education, Healthcare Improvement Scotland and the Alliance to make sure that Realistic Medicine is achieving its aims and working for professionals and patients.

Find out more here