NHS good but could be better in shared decision making

A SURVEY of healthcare professionals found that 76 per cent regularly practise core elements of shared decision making with patients but 28 per cent found lack of time a barrier.

The survey by the Patients Association asked how regularly healthcare professionals (1,416 respondents) practise all three core elements of shared decision making:

• Provide evidence-based information outlining treatment, care or support options, outcomes and uncertainties
• Provide decision support counselling to clarify options and preferences, either yourself or via a colleague
• Use a system for recording, communicating and implementing the patient’s preferences.

The survey report revealed that 36 per cent always did so and 40 per cent often did, with 21 per cent answering less frequently.

Reasons for not doing so included the process only being appropriate for some patients (45 per cent), patients not always being well placed to contribute to such decisions (29 per cent) and the view that not all of the core elements are necessary to achieve a good clinical outcome (25 per cent).

Asked to identify the top things that would make shared decision making easier – 28 per cent said more time, 11 per cent said better IT systems and eight per cent said more staff.

The survey also asked respondents whether their training had covered the three core elements and found that nearly one in four had not been trained in providing appropriate information to patients, and more than one in three had not been trained to counsel patients when making decisions. More recently-qualified respondents gave more positive answers but the average score for elements either not being mentioned at all or being mentioned only briefly was still 32 per cent for that cohort.

Among its recommendations the Patients Association is calling on the NHS to improve promotion of shared decision making approaches and ensure that any future efforts to improve IT capacity support shared decision making. It also believes that curriculums for healthcare professionals should be reviewed to ensure that no clinician or healthcare professional is able to qualify to practise without having been taught fully about shared decision making.

Professor Dame Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges, said: "The findings show that there is little debate among clinicians about the value and relevance of shared decision making. The issues are really about how to support and increase its practice.

"The Patients Association’s recommendations on better promotion of shared decision making, greater use of tools and improving training are spot on, as is the call on NHS Digital to ensure IT systems can best support professionals to work in this way."

Respondents to the Patient Association survey included GPs (19 per cent), practice nurses (12 per cent), hospital doctors (32 per cent), specialist nurses (22 per cent) and ‘others’ (16 per cent).

Link: Shared decision making from the perspective of clinicians and healthcare professionals