Health services need to promote shared decision making so people feel confident and empowered to be active in decisions about their care.
- Why we need to build patient awareness
- The Ask Three Questions approach
- Key actions to build patient awareness
Patients often go into a consultation expecting that their clinician will make the decision about what treatment they should have, and they do not feel confident or empowered to be involved. For many people, playing an active part in decisions about their own care means changing the way they approach the consultation.
These changes in patients’ expectations and behaviours don’t just happen.
- Active encouragement and an expectation that they will have the opportunity to participate in shared decision making in their consultations.
- 'Permission' to become more involved in discussions and decisions about their care and treatment.
- Clear and strong messages from their clinicians inviting them to become involved, which are reinforced by organisational support.
- Clinicians who are prepared to be flexible and have the awareness, knowledge and skills to deliver effective shared decision making.
- Appropriate time, either in or outside, the consultation to consider options.
A good first step is to build their awareness about playing a more active role in decisions about their care. This means providing information and materials which:
- Set out what is meant by ‘shared decision making’.
- Explain the benefits of shared decision making.
- Give people ‘permission’ and encourage them to play an active role in decisions about their own care.
- Give people some clear ideas of questions they can ask and how they can become more involved in decision about their own care.
The Ask 3 Questions approach is increasingly being adopted by a wide range of healthcare organisations to encourage and empower people. The approach is based on research by Shepherd et al. showing that encouraging patients to ask three simple questions leads clinicians to provide higher quality information about options and their benefits and harms.
Different organisations have tailored the materials according to local circumstances and use variations on the three questions, but they are in essence:
- What are my options?
- What are the possible benefits and risks of those options?
- How likely are the possible benefits and risks of each option to occur?
The invitation to Ask 3 Questions has been promoted in a wide range of ways and using a variety of materials such as posters, flyers, business cards, and even a short film, to raise patient awareness.
This video was developed as part of the Health Foundation's MAGIC Programme encouraging patients to 'just ask'. Hear more Patients, GPs, Commissioners and Nurses talk about Person-centred care on our web app.
The approach and materials can be tailored to be used at a number levels. It can be used across healthcare organisations such as Trusts or Health Boards, across healthcare settings such as hospitals and community services, and by individual clinical teams or within GP practices. It can be promoted beyond health services, through voluntary and community organisations.
- Start early and spend time planning and preparing your patient activation / involvement campaign.
- Plan at several levels – population, organisational, clinical service, local practice level.
- Use patient feedback methods to test and amend your awareness-raising materials.
- Test the measurement methods you plan to use with patients to ensure that any additional burden at the point of use (e.g. post clinic surveys) adds value.
- Be sure that you know where you have started from with patient mobilisation so you can measure progress.
- Listen to the groups you are trying to engage (e.g. through holding focus groups) – their points may be valuable and not a sign of resistance
- Involve external voluntary and community groups, such as the local diabetes support group or Expert Patient Programme, by providing awareness raising/training sessions to increase their ability to use shared decision making in their own environment and to prepare them to roll out information and materials to clients and at public meetings.