Measuring shared decision making: a review of research evidence

Date Reviewed:

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This report reviews evidence of the implementation of shared decision making in England and provides a summary of the types of measures that are available.

This report argues that it is important to measure the extent to which patients feel ready and able to take part in decisions regarding their health care and to measure the quality of the decisions that are made.  It finds that whilst there is a growing body of evidence around the benefits of shared decision making, it is not consistently happening for the majority of patients.  The report sets out some of the barriers to shared decision making identified in research and significant factors in achieving quality shared decision making.  It identifies a range of existing tools and measures, and the key features that are necessary if a tool is to be integrated into clinical practice.

The report sets out different purposes for measuring shared decision making, including to support policy development, to ensure communities benefit equally, to commission professional development, to inform commissioning, to support local improvement, and to understand the impact of shared decision makings.

It report identifies barriers to shared decision making as including time constraints, the perception that it is not appropriate for patients, that it is already happening, that patients don’t want it, that it is ineffective, and that there is no incentive to do it.

It identifies factors that have a significant impact on an individual’s readiness to make a decision and the quality of the decision include:

  • Understanding the treatment/management options available
  • Understanding consequences, both in terms of the benefits and risks of each treatment/management option
  • Feeling supported in the deliberation process
  • Feeling supported in whichever decision they choose to make
  • Having enough time to consider and digest the available options
  • Appropriate timing of decision support
  • Intervention

The report identifies a series of measurement tools that are currently available and concludes that in order for a measure to be integrated into clinical practice (and used for commissioning purposes) the measure must be:

  • Easy to administer, preferably self-administered
  • Flexible i.e. can be used with a decision aid or without
  • Quick to administer i.e. not too many items in the instrument
  • Easy to analyse, both for clinicians on a day to day basis and on an aggregated level 

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