Shared decision making

Many common conditions can be treated in different ways, but how different people balance the risks and benefits varies.  Shared decision making is based on an understanding that what is important to patients in terms of the impact treatment choices will have on their day to day life has an equal place alongside clinical expertise in deciding whether or what treatment to have.

What is shared decision making?

‘It’s about a meeting of two experts: the patient who’s an expert in their life and the clinician who is obviously an expert in the different treatment options,’ says Sam Hood, Commissioning manager at Gateshead CCG.    Shared decision making recognises that different people have different goals and concerns, so reaching a decision about treatment or care needs to be a collaborative process between the individual and their health professional or team.  Colin Leybourn, who lives with diabetes, says ‘Health professionals know the medical stuff, but I know myself and how different things affect me – even my emotions.’

Why should we do it?

‘With my commissioner hat on, it’s important that the right people get the right care, and people aren’t getting care that they don’t either want or need,’ says Mark Hayes, GP and commissioner.  In his paper Patients’ preferences matter: stop the silent misdiagnosis Al Mulley, international visiting fellow at the King’s Fund, argues that what patients want is often different from what doctors think they want, and when they are well informed, people make different choices about treatment.  There is also evidence that shared decision making improves patient’s satisfaction, involvement in their care and knowledge of their condition.

  • Read Anna Dixon’s blog for The King’s Fund: Are we wasting money on care that patients don’t want?
  • Read our review of the evidence considering whether shared decision making is worthwhile, including the impact on patient experience, satisfaction and confidence. 

Are people ready for shared decision making?

People 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.  The ‘Ask 3 Questions’ approach encourages people to ask three simple questions, which evidence shows leads clinicians to provide higher quality information about options and their benefits and harms.  The questions are:

- What are my options?

- What are the possible benefits and risks?

- How can we make a decision together that is right for me?

  • View a three-minute video designed to help people to feel more confident to ask questions and participate in decisions about their treatment and care. 
  • View, download and adapt for local use materials created by the Health Foundation’s MAGIC programme encouraging people to play a more active role in decisions about their own care.

How can we help people understand complex information and make choices?

There are an increasing number of resources – often called ‘decision support materials’ or ‘patient decision aids’ – that have been designed to help people understand complex information about potential options for their treatment, and to think through what is important to them.  One approach is Option Grids, which are one-page evidence-based tables that summarize treatment or screening options.  They are specifically designed to answer the questions people most commonly ask and to enable them to easily compare their options. 

Recommended resources

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

This report provides a clear and helpful overview setting out what shared decision making is, why it is important, when it is appropriate, how it can be implemented and some of the challenges to be addressed when implementing it.

Decision support materials

This page features a range of decision support materials for specific conditions as well as some generic material to help people with decision making.

Six steps of shared decision making for health care providers

This brief set of slides sets out six easy-to-adopt steps that healthcare professionals can use to better engage people in making decisions about their care.

See all our pages on shared decision making

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