©2011 the Strategic Projects Team Part of the Strategy & Policy Directorate

Embedding Shared Decision Making in Routine Care

Dr Steven Laitner@SteveLaitner

Online Learning Series Right Care for Populations

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What is Shared Decision Making

• as active partners with their clinician;

• in clarifying acceptable medical options;

• and in choosing a preferred course of clinical care.

Shared decision-making is a process which involves Patients:

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What are they sharing?

Clinicians

DiagnosisCause of disease PrognosisTreatment optionsOutcome probabilities

Patients

Experience of illness

Social circumstances

Attitude to riskValuesPreferences

• Diagnosis• Cause of disease • Prognosis• Treatment options• Outcome probabilities

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%

Wanted more involvement in treatment decisions:

Source: NHS inpatient surveys

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Choice of Modality

• 38%

20%

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Some quotes from our Service User Reference Group

“recognise the “patient” as an expert in themselves”

“listen to us”

“don’t only concentrate on the clinical”

“be aware that management of the LTC is only a small part of my life”

“I want to be seen as a whole person” (ortho example)

“stop using language and knowledge as a barrier”

“speak to me with respect”

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2x

10x

Importance of patient preferences

Consensus about evidence / necessity

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Variation in UK

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Risk Groups and Survival

Low Risk (33.5%)

Medium Risk (56.7%)

High Risk (8.9%)

Chandna SM et al. Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity. BMJ 1999; 318 : 217-223.

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Decision Aids reduce rates of discretionary surgery

RR=0.76 (0.6, 0.9)

O’Connor et al., Cochrane Library, 2009

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Why shared decision making?

The benefits are:

• Improving patient satisfaction, experience, knowledge;• Helping patients make healthcare choices aligned with

their personal needs, values and circumstances;• Improving clinical outcomes and safety; • Achieving the right intervention rate and reducing

unwarranted practice variation;• Reducing cost and litigation costs.

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The National SDM Programme

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Established Kidney Disease (x 3)Cataracts

AAA Repair Pregnancy after c-section Depression

AAA Screening Menorrhagia Blood pressureOsteoarthritis Hip Rheumatoid Arthritis COPDOsteoarthritis of the knee Carpal tunnel syndrome Atrial Fibrillation

BPH (LUTS) Stable angina SciaticaPSA Testing Serous Otitis Media Inguinal HerniaLocalised Prostate Cancer Recurrent Tonsillitis Acne

Localised Bladder cancer Type 2 NIDDM (x 2) Cholecystitis

Localised Lung cancer Smoking cessation Obesity

Localised Breast Cancer Cholesterol Amnio/CVS

Totally

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“Give people the care they need and no less; the care they want and no more”

Al Mulley

steven.laitner@nhs.net

Twitter: @SteveLaitner

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Since March 2013, the national shared Decision Making Programme is being run by the NHS England Patients and Information Directorate.

You can find out more about the SDM programme at the NHs Networks site here:

http://www.networks.nhs.uk/nhs-networks/shared-decision-making-sdm

The Patient Decision Aids can be found here:

http://sdm.rightcare.nhs.uk/

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