Shared Decision Making

Update to NHS RightCare Patient Decision Aids

As part of the wider work ongoing in NHS England around Shared Decision Making and Person Centred Care, we advise users that the current NHS RightCare Patient Decision Aids (PDAs) are to be removed from this website and NICE Evidence Search in March 2018.

Why are the decision aids being removed?

This decision has been taken as the format and information provided in the PDAs requires extensive review and updating to keep them as a high quality resource for use by clinicians, commissioners, patients and the public.

What happens next?

Over the coming months, we will update this page with useful resources and links to PDAs that provide the most up-to-date advice and treatment options for use by commissioners, clinicians, patients and people. These will be in place alongside the removal of PDAs.

The current NHS RightCare PDAs will remain available until March 2018 and can still be used until the new repository of resources is made available.

Shared Decision Making (SDM) is a collaborative process through which a clinician supports a patient to reach a decision about their treatment. The conversation brings together:

  • the clinician’s expertise, such as treatment options, evidence, risks and benefits, and;
  • what patient knows best: their preferences, personal circumstances, goals, values and beliefs.

NHS RightCare Patient Decision Aids

Twenty-eight short form Patient Decision Aids (PDAs) have been developed to support patients to have informed conversations about their condition with clinicians.  The below PDAs are now available on the National Institute for Health and Care Excellence (NICE) evidence search website.

Abdominal Aortic Aneurysm (AAA): Repair Abdominal Aortic Aneurysm (AAA): Screening
Acne Birth options after previous caesarean section
Bladder cancer: High risk non muscle invasive Carpal tunnel syndrome
Cataracts Chronic Obstructive Pulmonary Disease (COPD)
Depression Down’s Edward’s and Patau’s Syndromes
Established kidney failure Established kidney failure: Dialysis
Established kidney failure: Transplant Gallstones
Glue ear Heavy menstrual bleeding
Inguinal hernia
Lung cancer Obesity
Osteoarthritis: Hip Osteoarthritis: Knee
Prostate specific antigen (PSA) testing Rectal cancer: without distant spread
Recurrent sore throat Rheumatoid arthritis
Smoking Cessation Stable Angina

Why Shared Decision Making is important

It encourages better decisions about health care.

In Shared Decision Making two sources of equal expertise come together to enable better decisions – clinician and patient. In Shared Decision Making the patient’s knowledge and preferences are taken into account, alongside the clinician’s expertise. The decisions they reach in agreement with each other are informed by evidence on effective treatment, care or support. This leads to better decisions and outcomes for both the patient and clinician.

As well as the clinical reasons to undertake Shared Decision Making, it is important from an ethical point of view to make sure that patients have unbiased and clear information on options, benefits and harms. It is the right thing to do.

A recent landmark case, Montgomery v Lanarkshire Health Board (Scotland, 2015) has focused on the legal requirements to undertake Shared Decision Making. The importance of a patient’s right to make their own decision has been advocated in legal cases before, but the Montgomery case confirms that the need for ‘informed consent’ is firmly part of English law.

This ruling recognises a growing appreciation for patient’s self-determination and ability to understand the consequences of a particular treatment. Clinicians now have a clear duty to take reasonable care to make sure that patients are aware of material risks. Shared Decision Making is a key way of ensuring this.

What is the evidence for effective Shared Decision Making?

Evidence shows that what makes Shared Decision Making successful is the collaborative conversation. The Health Foundation reviewed the evidence from 11 large scale change projects which covered a wide range of areas. Key learning from the reviews includes:

  • Decision support tools (such as patient decision aids) alone will not achieve Shared Decision Making
  • Offer people a range of support options, so that they can select to suit preferences and needs
  • Recognise that people are different and tailor interventions appropriately.
  • Changing the role of clinicians is vital, challenging, but not impossible.
  • Train the whole team, not just individuals

What are the key elements of Shared Decision Making?

There are a number of different models of Shared Decision Making, but it is possible to define the core concepts. The key concepts include ‘patient values/preferences’ and ‘options’. The diagram below outlines a model built from a consensus of concepts

Learn more about Shared Decision Making from the following organisations: