The Shared Decision Making programme was part of the Quality, Innovation, Productivity and Prevention (QIPP) Right Care programme. It ended on 31 March 2013, and now it is the responsibility of NHS England. It is our objective to embed Shared Decision Making in NHS care.
In 2012, the programme commissioned three workstreams, with the aim to embed the practice of shared decision making among patients and those who support them, and among health professionals and their educators. The three workstreams were:
i) Developing tools which support shared decision making, and the provision of decision coaching
36 Patient Decision Aids (PDAs) have been created by Totally Health, designed to help patients understand and consider the pros and cons of possible treatment options and to encourage communication between them and their healthcare professionals. The PDAs feature evidence-based information, images, diagrams and animations.
The PDAs are available online and in paper format, so patients and their carers, if appropriate, can examine their options in their own time. Short versions are available which can be used in or outside the consultation. Mobile apps have also been developed, so the information is accessible anywhere.
ii) Embedding Shared decision making in NHS systems and processes
Making Shared Decision Making a reality for patients can only be achieved if it is systematically streamlined into routine NHS processes, steering clear of lengthy bureaucratic processes.
Capita Business Services undertook activities for integrating shared decision making, so it becomes an integral part of the patient and clinician pathway. The PDAs, for example, need to be easily accessible on recognised NHS platforms, such as Choose and Book, NHS Choices, GP patient record systems and Map of Medicine.
As well as embedding shared decision making from the provider perspective, this workstream worked to integrate SDM into policies, commissioning systems and consent procedures. The programme provides information, insight and advice about how NHS England and Clinical Commissioning Groups (CCGs) can deliver on their statutory duties, including practical tools and processes, and indicators of what ‘good commissioning of shared decision making would look like’ at NHS England and CCG level.
iii) Creating a receptive culture for shared decision making
The biggest challenge to embedding shared decision making in routine NHS care is to create a nationwide paradigm shift so patients expect to be routinely involved in decisions about their care. This requires a change in the current patient-clinician dynamic so that clinicians work with patients to encourage and respond to their greater involvement and patients take a stronger interest in being involved.
In this workstream, AQuA developed a training and education programme for providers, including nurses, GPs, consultants and NHS managers, as well as commissioners.
Alongside that, undergraduate and postgraduate medical training was developed on enhanced communication skills and shared decision making, and there are plans to work with clinical education providers to embed and enhance their curricula. Video and wiki tools were also created to support these workstreams.
Harnessing a multi-media approach to foster a social movement for shared decision making, the programme has raised awareness amongst patients, their carers and the wider public, working with partners such as Patient Opinion and advocates within the voluntary sector.