Shared decision making ensures that individuals are supported to make decisions that are right for them.
Shared decision making: People are supported to a) understand the care, treatment and support options available and the risks, benefits and consequences of those options, and b) make a decision about a preferred course of action, based on evidence-based, good quality information and their personal preferences.
Shared decision making is a collaborative process that involves a person and their healthcare professional working together to reach a joint decision about care. It could be care the person needs straightaway or care in the future, for example, through advance care planning. It involves choosing tests and treatments based both on evidence and on the person’s individual preferences, beliefs and values. It means making sure the person understands the risks, benefits and possible consequences of different options through discussion and information sharing.
This joint process empowers people to make decisions about the care that is right for them at that time (with the options of choosing to have no treatment or not changing what they are currently doing always included).
Shared decision making requires skill from health professionals and most importantly a willingness to involve their patient in decisions about their care. Health professionals also need to recognise that patients, particularly those with lower levels of health literacy, may need support to take a more active partnership role with their care professional. To be successful, it relies on two sources of expertise:
- the health professional as an expert on the effectiveness, probable benefits and potential harms of treatment options
- the person as an expert on themselves, their social circumstances, attitudes to illness and risk, values and preferences.
In any decision where there is more than one option, the values and preferences of the person, such as their attitude to risk, may be as important as the clinical evidence in choosing which option to follow.
Shared decision making enables people to align their preferences to treatment options that are clinically valid. It does not mean that people can choose clinical treatments that have no evidence base.
Both parties must be willing to share information and accept shared responsibility for joint decision-making. This may only be a subtle change of practice for some, but it could feel like a dramatic one for others and especially for the person involved.
Shared decision making is now consistently quoted as a key tenet of modern healthcare but is often not fully practised by clinicians or experienced by patients. There is still a significant perception gap between what patients want and what clinicians think patients want.
Personalised care and shared decision making
National surveys tell us that over 40% of people want to be more involved in decisions about their care; this situation has hardly changed in two decades. In addition, research studies have consistently shown that when people are more involved in decisions they:
- have fewer regrets about decisions to do with their health and care
- report better relationships with clinicians
- adhere better to treatment
- report a better experience including more satisfaction with the outcome.
This means that by adopting the personalised approach of involving people in decisions about their health and care we will improve health and wellbeing, improve the quality of care and ensure people make informed use of available healthcare resources. Involving people in their own health and care not only adds value to people’s lives, it creates value for the health and care system. The challenge is how to continue to emphasise that the focus of care and support services has moved from ‘what is the matter with you?’ towards ‘what matters to you?’.
National Institute for Health and Care Excellence shared decision making collaborative
The National Institute for Health and Care Excellence-led shared decision making collaborative is a group of organisations and individuals committed to thinking collectively about the role of shared decision making in UK health systems, drawing on international experience. It comprises a range of organisations from the statutory sector, patient and voluntary sector organisations and academia.
NHS England is a key partner within the collaborative and contributes to a number of its priorities, including:
- leadership and culture change
- local leadership
- shared decision making tools
- measurements of successful shared decision making