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Shared Decision Making

How do we involve patient in decisions about their health and well-being? Do we do it effectively?

Patients report they want to be involved in their health and wellbeing, research tells us that people who are more involved have better experiences and improved health. However, we know from conversations we have had with our local GP’s, Practice Nurses, patients and communities, that involving patients in decisions about their health and wellbeing is variable and can be tricky.

How do we support people to have a stronger voice in decisions about their health and care, and is this really what people want?

The traditional relationship between clinicians and patients is for clinicians to solve health problems - find out what’s wrong and fix it. But what if a different approach was taken? Such as spending time finding out what matters to a patient, finding solutions together that work for the patient and inviting and enabling them to make it happen through shared decision making? Would that be a better approach?

We think shared decision making is the middle ground between the more traditional clinician-centred practice, where patients rely on their doctor or healthcare professional to make decisions about their care, and patient choice, where people are given information and then left to make their own choices. It recognises clinicians have access to knowledge about treatment options, their risks and benefits, while patients have knowledge on what is important to them, their own goals and their preferences. It brings together in a conversation these different contributions and these complementary areas of expertise. Is this the way forward?

diagram

Common examples of where it is used include decisions about:

  • undergoing screening or a diagnostic test
  • different medical or surgical procedures
  • self-management of a long-term condition
  • making a change in lifestyle
  • taking medication.

This approach to increasing a patient’s involvement in making decisions about their own treatment and care could be used across the whole health system but we think beginning in GP practices with GP's and Practice Nurse is a good starting point. We could then look at widening out the approach if it successful.

For the approach to be successful, it would require clinicians and patients to re-think their attitudes and expectations. Like all skills, shared decision making needs practice and if local patients and clinicians feel this is the way forward we are committed to ensuring Liverpool has the right knowledge, skills, tools and confidence to put this approach into practice, whether this is through additional training for clinical colleagues or empowering and educating patients.

Do you think we should empower people to have more involvement in their health care? Here's what we are proposing

We are proposing for shared decision making to be implemented in appropriate GP and Practice Nurse consultations.

Some consultations, due to their nature, are not suitable for a shared decision making approach e.g. acute tonsillitis where the treatment option is obvious and restricted, whilst others will be more appropriate e.g. osteoarthritis and other long-term conditions, we are working with clinical colleagues to understand which conditions would be most suitable and would then look at how shared decision making could be used across the health system, i.e. in hospitals and in the community. This engagement is about getting the approach right, understanding what's important for Liverpool people and shaping how we move forward with supporting people who want to be involved in decision about their care to feel empowered to do so..

We know the level of involvement people have in decisions about their health care varies and we want to make sure where shared decision making is appropriate, people are supported to participate in decisions about their care. Below are a couple of senarios to show case the difference involving a person in decisions about their health care can make.

Do you recognise either of these scenarios? 

A consultation with no shared decision making

I’m standing at the reception desk at my GP practice. I register my details and take a seat in the waiting area. It’s a nice new health centre, with light airy surroundings but I’m feeling a little anxious and very much aware of all the other people around me. When my name appears on the screen I head into see the doctor.  She asks me how I am and I tell her the reason I’ve come . . . my osteoarthritis is playing up and I’m in terrible pain.The doctor asks me questions which I try to answer, although I feel a bit tongue-tied. I’m quite a confident person at work and home but strangely, in front of my doctor I don’t feel able to express myself very well and feel very much like a patient. The doctor listens and types things on her computer; I’m not sure what she is writing. I’m getting to the point where I’m going to mention that I think some support to introduce simple exercises into my daily routine might help, when she’s writing a prescription and I feel like my time is up. I leave with no intention of picking up the prescription as I don’t want any more medication; I’m on 4 tablets a day already! I think maybe I’ll see how the pain goes. Or perhaps I’ll try one of the other doctors in a week or so.

A consultation that takes a shared decision making approach

I’m standing at the reception desk at my GP practice. I register my details and take a seat in the waiting area. It’s a nice new health centre, with light airy surroundings but I’m feeling a little anxious and very much aware of all the other people around me. When my name appears on the screen and I head into see the doctore.  She asks me how I am and I tell her the reason I’ve come . . . my osteoarthritis is playing up and I’m in terrible pain.The doctor asks me how the pain impacts what is important to me and we talk about how it’s preventing me from playing with my beautiful grandchildren and the impact its having at work. The doctor listens and talks to me about my condition and what causes it. She tells me there is damage in and around the joints that my body cannot fully repair. We then discuss what my options are, what each option would mean for me and what the likely benefits are. The doctor says she can prescribe some pain killers if I want but I’m on 4 tablets a day already and I don’t want to take any more. Instead we discuss alternatives and I’m pleased to hear that regular exercise and losing weight can help to manage my pain, I thought exercise might help and wanted to suggest it. The doctor tells me about an organisation that is running lots of activities in the local park and community centre, they even offer yoga and chair exercise classes for free. I’m given information on where I can find more details and I leave pleased with the outcome of my visit and feel hopeful about my health for the first time in ages. Perhaps I won’t have to visit the doctor again for quite a while. Instead I can use the free time to exercise!

Useful Links

Ask 3 questions - helping people get more involved in their health and care

The Kings Fund - People in control of their own health and care

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Be better informed about your right to choice in the NHS

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