Decision support materials give evidence-based information that patients and their health professional can use to reach a decision together.
Identifying and making a decision on the best health treatment or screening option can be difficult for patients and often involves understanding complex information. Decision support materials help people and their families to understand their options so they are better equipped to make an informed decision that aligns with their preferences.
This section sets out:
- What are decision support materials?
- Why use decision support materials?
- Types of decision support materials
- How to use decision support materials
Decision support materials describe where and why choice exists and provide information about the options available. Typically decision support materials will provide information on the potential outcomes, benefits and risks for each option, and the frequency and likelihood of these. This helps people to consider their options from a personal perspective (e.g. how important the possible benefits and harms are to them) and helps them to participate with their health professional in making a decision.
Different types of support materials can be used before, during or after consultations and are designed to supplement the interaction between a healthcare professional and patient, not to replace it. Some, such as option grids, are brief enough to be used in the consultation with the healthcare professional, whilst others, such as web-based patient decision aids, are more detailed and are designed to be used by the patient before their consultation and after the consultation to reflect on their options.
It is important for patients to understand that there are options and choices for almost every healthcare decision, including the option to do nothing. This means that clinical teams need to present complete and balanced information on all the reasonable options a patient might have. Decision support materials can help healthcare professionals structure their consultations, providing clear evidence-based information that enables the clinician and patient to review treatment options together using the best available evidence.
For patients, these tools may help clarify what is important to them in their treatment and care, based on their personal preferences, values, attitude to risk, lifestyle and circumstances.
Decision support materials are particularly helpful for complex decisions that need detailed information and more careful consideration. There may be multiple options, each with features that different people will value differently and which will influence their choice.
Research shows that using decision support materials not only improves the individual’s knowledge of their options, including the benefits and harms of those options, but also help people to make choices that are more consistent with their informed values, while fostering collaboration with their provider.
Research for a recent Cochrane Review also indicated that use of decision aids reduced the choice of major elective surgery by 20%.
Decision support materials come in a range of formats including information leaflets and booklets, DVDs and audio tapes, and interactive media and web-based tools. They also differ in how they present information to enable people to consider their options from a personal perspective. Some of the most common approaches are Patient Decision Aids, Brief Decision Aids, and Option Grids.
Patient Decision Aids
This tends to be the term used for decision support materials that are quite detailed and extensive in their content. Typically, patients will have access to these before a consultation with a healthcare professional and may use and refer to them to reflect on information about treatment options afterwards.
A wide variety of patient decision aids developed by the NHS Right Care programme are available on the NHS Shared Decision Making website.
The NHS Rightcare programme has also developed a range of Decisions Aid Apps for Android phones which are free to download.
Brief Decision Aids
Brief Decision Aids are designed to be used within the consultation, but also as an additional source of information for the patient to read outside the consultation. Designed to fit the way clinicians and patients already talk in consultations, Brief Decision Aids use high quality evidenced-based information to provide up to date risk communication with common denominators, real numbers, absolute risk data, plain language.
The team in Newcastle working on the Health Foundation’s MAGIC programme have developed a wide range of Brief Decision Aids. These are available for download from this Resource Centre.
Option Grids are designed to be used during consultations to help people to compare reasonable treatment or screening options. The information is set out in a grid-format with the questions that patients most frequently ask in the rows and the answers relevant to each option in the columns. In this way patients can easily compare issues that are important to them and how the different options affect those issues.
As well as healthcare professionals using option grids to facilitate a shared decision making conversation, patients can also take them away to use as a prompt for further thinking and questions about their options.
There is also the potential to link the grids to more extensive decision support materials, such as DVDs or a web based tools.
A wide variety of option grids has been developed by the Cardiff-based Option Grid Collaborative of over 90 patient representatives, medical experts, and clinicians. The option grids are available on the Option Grid website.
Teams working on the Health Foundation’s MAGIC programme to implement shared decision making also found that developing option grids together helped to create a more consistent approach to giving information and decision-making within the team. The International Patient Decision Aid Standards (IPDAS) Collaboration has developed quality standards and guidance to support teams interested in developing patient decision aids.
There are some practical approaches that can help health professionals to incorporate decision support materials into their practice. Some approaches used by sites working on the Health Foundation's MAGIC programme include:
- Creating a concertina file of different decision support materials for use in GP practices
- Installing icons linking to each decision support material on the computer desktops in GP practices
- Discussing a different support material at the practice meeting each month, giving GPs an opportunity to familiarise themselves with the content and increasing their confidence in using it
There are also some approaches to using them in a consultation. The example below illustrates the key steps in using an Option Grid within a consultation.
Step 1 “Here is an Option Grid”
Tell the patient that the Option Grid is a summary of the reasonable options available to them. Hand it to the patient to look at.
Step 2 “Please take a look at it”
This step allows the patient to read the Option Grid. Check whether the patient is willing to read the Grid or whether they want you to explain the options.
Step 3 “Highlight the bits that matter to you”
Ask patients to highlight issues that matter most to them. This will allow the patient to develop ownership of the information and give them confidence to ask questions. You can then guide them through the options in relation to what matters most to the patient.
Step 4 “Any questions?”
Encourage the patient to ask questions and to compare the options.
Step 5 “Take it home”
Most Option Grids will be linked to more extensive tools that are designed to be used outside the consultations, such as a DVD or a website. Remind the patient to use these as well as the Grid. Tell the patient that they can take the Option Grid home and share with others before coming back to ask more questions.
The NHS National Prescribing Centre has developed a series of short videos of real GPs using patient decision aids in realistic, unscripted consultations with simulated patients