How should decision support tools be implemented?
Ensure patients have access to decisions support tools
Patients should be able to access relevant decision support tools before, during and after the consultation at hospital, community setting or a GP practice.
Prior to the consultation:
Where appropriate (for example if a diagnosis is known), decision support tools should be sent to patients before their consultation by the patient’s preferred method either post, email or electronic record.
Patients should be encouraged to read the decision support tool before their consultation and consider what matters to them, what they hope to happen as a result of the discussion and what questions they would like to ask. Reassure patients that anything that is not understood in the decision support tool can be discussed with the patient’s clinician at their appointment.
Offer additional support for those people who might find it difficult to share in decision making especially if they do not want or do not have the support of a family member or friend, who may be able to help them make sense of the decision support tool.
Encourage the person to take an active part in decision making and reassure them that shared decision making will be supported by the clinician.
Additional support should be commissioned as part of an integrated care pathway. It could be provided by a care co-ordinator, through peer support networks and/or VCSE organisations.
During the consultation:
The decision support tool should also be readily available to patients during the consultation.
The tools should be provided in a way that is accessible and appropriate for each individual patient. Some tools are designed to be printed so that people can write on them and keep them for reference. In some circumstances, an electronic version may be more suitable.
Following the consultation:
A summary of the consultation and decision-making process should be captured and shared with the patient after the consultation to look through in their own time. This is in line with Academy Royal Colleges which advocates writing letters directly to patients. Ideally a copy of this letter should also be made available via the patient’s Personal Health Record (PHR).
Ensure clinicians have decision support tools readily available at the point of care
Access to decision support tools: Decision support tools should be readily available to clinicians at the point of care. This could be facilitated by integrating with the electronic patient record system.
Recording on electronic record: When documenting the discussion (for example in a person’s clinical notes or support plan), clinicians should record any decisions made along with details of what the person said was important to them in making those decisions. This should be shared with the person and with other relevant professional involved in the person’s care pathway.
Enable two stage decision making (including a short period of reflection): Clinicians should be encouraged and enabled to implement a two stage decision making process which introduces a period of reflection for patients when deciding on treatment and giving consent. This gives patients time to fully understand the benefits and risks of treatment, discuss it with others (if they want) and decide whether it is the most suitable option for them. Provide details to the patient as to how to share their reflections and final decision back with the clinician. For patients considering high risk surgery, the second shared decision making conversation should take place following peri-operative risk assessment.
Consider workforce training and development needs: To get the most out of decision support tools it is important that clinicians understand the benefit of using them and have the skills to incorporate them into a shared decision making process. There is, therefore, the need to provide training and education to upskill the workforce on shared decision making and the use of tools.
- The Personalised Care Institute (PCI) has free e-learning on shared decision making and a recorded webinar on decision support tools. (registration is required).
- You may also consider whole teams training and a list of accredited providers are available via the Personalised Care Institute.
- Clinical champions who can support the implementation shared decision making are recommended by the National Institute for Health and Care Excellence (NICE). These champions will be able to provide training and support in using decision support tools.
Measurement and evaluate the impact
Evaluating the integration of 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:
- Patient experience
- Clinical experience
- Supportive systems
- Impact measures
Find out more in the Evaluating the Impact section.