Guidelines on ‘shared decision-making’ for doctors

DOCTORS should take time to discuss treatment options with patients and encourage them to talk about their condition, according to a new report from the King’s Fund.

Making shared decision-making a reality: No decision about me, without me aims to set out how clinicians can engage in ‘shared decision-making’ with patients during consultations. The report is a response to health secretary Andrew Lansley’s vision of an NHS that places patients’ needs, wishes and preferences at the heart of clinical decision-making.

The King’s Fund define shared decision making as "a process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient's informed preferences".

Their report details the skills and resources required to implement it and also outlines what action is needed to make this vision a reality.

According to the report, the principle of shared decision-making in the context of a clinical consultation is that it should:

  • support patients to articulate their understanding of their condition and of what they hope treatment (or self-management support) will achieve
  • inform patients about their condition, about the treatment or support options available, and about the benefits and risks of each
  • ensure that patients and clinicians arrive at a decision based on mutual understanding of this information
  • record and implement the decision reached.

The importance of communication skills is highlighted in the report which suggests that tools to help patients make decisions are just as important as guidelines for doctors.

The report authors Angela Coulter and Alf Collins acknowledged in a recent Guardian article that shared decision-making is not “the norm” in the NHS and admitted it would be “impossible to achieve unless doctors can be persuaded to change their view.”

They added: “It’s time for all those involved in healthcare to wake up to the aspirations of 21st century patients - we want decisions to be made with us, not for us.”

Links:

Making shared decision-making a reality: No decision about me, without me