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Embedding Shared Decision Making in Routine Care

Online Learning Series Right Care for Populations. Embedding Shared Decision Making in Routine Care. Dr Steven Laitner @ SteveLaitner. What is Shared Decision Making. Shared decision-making is a process which involves Patients :. as active partners with their clinician;

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Embedding Shared Decision Making in Routine Care

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  1. Online Learning Series Right Care for Populations Embedding Shared Decision Making in Routine Care Dr Steven Laitner @SteveLaitner

  2. What is Shared Decision Making Shared decision-making is a process which involves Patients: • as active partners with their clinician; • in clarifying acceptable medical options; • and in choosing a preferred course of clinical care.

  3. What are they sharing? Clinicians Diagnosis Cause of disease Prognosis Treatment options Outcome probabilities Patients Experience of illness Social circumstances Attitude to risk Values Preferences • Diagnosis • Cause of disease • Prognosis • Treatment options • Outcome probabilities

  4. Wanted more involvement in treatment decisions: % Source: NHS inpatient surveys

  5. Choice of Modality 20% 38%

  6. Some quotes from our Service User Reference Group “recognise the “patient” as an expert in themselves” “listen to us” “don’t only concentrate on the clinical” “be aware that management of the LTC is only a small part of my life” “I want to be seen as a whole person”(ortho example) “stop using language and knowledge as a barrier” “speak to me with respect”

  7. Consensus about evidence / necessity 10x 2x Importance of patient preferences

  8. Variation in UK

  9. Risk Groups and Survival Low Risk (33.5%) Medium Risk (56.7%) High Risk (8.9%) Chandna SM et al. Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity. BMJ 1999; 318 : 217-223.

  10. Decision Aids reduce rates of discretionary surgery RR=0.76 (0.6, 0.9) O’Connor et al., Cochrane Library, 2009

  11. The benefits are: Improving patient satisfaction, experience, knowledge; Helping patients make healthcare choices aligned with their personal needs, values and circumstances; Improving clinical outcomes and safety; Achieving the right intervention rate and reducing unwarranted practice variation; Reducing cost and litigation costs. Why shared decision making?

  12. The National SDM Programme

  13. Totally

  14. “Give people the care they need and no less; the care they want and no more” Al Mulley steven.laitner@nhs.net Twitter: @SteveLaitner

  15. Since March 2013, the national shared Decision Making Programme is being run by the NHS England Patients and Information Directorate. You can find out more about the SDM programme at the NHs Networks site here: http://www.networks.nhs.uk/nhs-networks/shared-decision-making-sdm The Patient Decision Aids can be found here: http://sdm.rightcare.nhs.uk/

  16. Online Learning Series Right Care for Populations • Follow Right Care online • Subscribe to get a weekly digest of our blog alerts in your inbox, • Receive occasional eBulletins • Follow us on Twitter @qipprightcare Find the full series at: www.rightcare.nhs.uk/resourcecentre

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