Shared decision making is a fundamental component of personalised care and is an ethical, professional and medicolegal standard for health and care related decision making. However, the process is not always easy. Decision support tools support patients and clinicians to work together to decide on the best course of action by ensuring the most up-to-date and evidence based information is discussed and the preferences and values of the individual are identified and included in the decision making process. Although these tools are not required for shared decision making to take place, they can make the process easier for patients and clinicians.
These tools help people make the right decision for them considering their unique circumstances, preferences and values. The use of these tools is associated with patients being less likely to reconsider health-related decisions further through their healthcare pathway and can lead to fewer patients wanting to proceed to surgical intervention. These tools can be used before, during or after a clinical consultation but they do not replace the need for a detailed discussion with a clinician skilled in shared decision making. When used by a clinical team skilled in shared decision making, they ensure that patients are at the heart of decision making. These tools enhance, rather than replace, the clinical decision making consultation.
What decision support tool are not
- They do not tell people what to do.
- They do not prioritise one option over others.
- They do not aim to influence the decisions people make.
- They do not replace a good conversation with a health care professional.
NHS England is committed to the integration of decision support tools into pathways of care and they are a core component of the Delivery plan for tackling the COVID-19 backlog of elective care as they help to ensure that only people who want surgery go on to have it. These tools support the requirement to move towards two stage shared decision making across all admitted pathways by April 2024.
Two stage decision-making introduces a period of reflection for patients when deciding on treatment options and giving consent. This allows patients to take the time to fully understand the benefits and risks of treatment, talk with friends and family and decide whether it is the most suitable option for them. Integrating these tools into this decision making process will support providers in meeting this requirement.