Evaluating decision support tools might be incorporated into assessing the wider impact of personalised care or be part of a specific quality improvement programme. It is important to evaluate their use from the perspective of:
There are a number of patient-reported measures of the shared decision making process. The three-item CollaboRATE shared decision making score or nine-item item shared decision making questionnaire are perhaps the most commonly used in the United Kingdom.
Feasibility and ease of use of decision support tools for clinicians is pivotal to their adoption. Understanding barriers to adoption at the level of a team or a pathway is of great importance and we recommend a plan, study, do act (PDSA) approach to facilitate adoption.
It is important to measure the degree to which:
- patients are systematically being prepared to share decisions
- clinicians can readily embed decision support tools into everyday care processes
- clinicians can record the fact that a shared decision making conversation has taken place and the outcome from the discussion with the patient.
Coding shared decision making
Use the following SNOMED codes to record whether or not a decision support tool has been used:
- 815751000000108 | Shared decision making with decision support (procedure)
- 815791000000100 | Shared decision making without decision support (procedure)
Providers will need to ensure the code is mapped to the correct selectable fields in the user interface, based on their own electronic patient record (EPR) system being used.
Shared decision making ensures decisions align with the evidence base and with individual circumstances, preferences and values. In other words, shared decision making is a process that connects informed patients to their preferred treatment, care or support option. Given this linking function, assessing the impact of this process usually means measuring changes in service utilisation over time – for instance, are more people choosing alternatives to surgery as a result of implementing shared decision making in a surgical pathway?
The other areas that change might be observed are:
- Improved treatment adherence and treatment satisfaction
- Improved experience of care data – for example Q34 Surveys – Care Quality Commission (cqc.org.uk) and others
- Reduced complaints relating to shared decisions
- Reduced litigation (causal)
- Reduced unwarranted variation in care delivery
- Reduced health inequalities