Summary

Recognising the need for increased patient involvement in healthcare decisions, the UK Government called on key players in the National Health Service (NHS) to make shared decision-making a healthcare norm.1 Multiple initiatives (including the NHS Choice Framework and the Comprehensive Model of Personalised Care) have been launched to increase patients’ access to accurate healthcare information to facilitate shared decision-making, as well as increasing healthcare providers’ awareness and application of shared decision-making.2 3 These initiatives are expected to improve quality of care, patient outcomes and healthcare efficiency over the next decade.3

 

Problem

Shared decision-making (SDM) refers to a collaboration between patients and their healthcare providers, with both parties sharing responsibility for a healthcare decision. Healthcare providers offer medical expertise and treatment options, while patients contribute their lived experiences, values and healthcare preferences.4 5 Research shows that SDM improves patient outcomes, regardless of patients’ preferences for involvement.6 Patients may change their minds about treatment choices following increased involvement in their care, with many patients choosing fewer treatments.7

Over 95% of British people support patient involvement in healthcare decisions, and 75% of patients in the UK feel that patient choice is an important part of healthcare.8 9 However, there are several key challenges in implementing SDM in the NHS, including: providing accessible and accurate healthcare information for patients; educating healthcare providers, patients and carers about SDM; and identifying the levels of SDM support needed by patients with different social, literacy and healthcare needs.10-12

Solution

Recognising the need for increased patient involvement, the UK Government published a report calling on key players in the NHS to make SDM – summarised as ‘no decision about me, without me’ – a healthcare norm.1 The UK’s Department of Health and Social Care (DHSC) subsequently released two more reports outlining strategies for implementing SDM in the NHS.10 12

 

What has it achieved?

The NHS Choice Framework, published by the DHSC in 2016, outlines the nine types of choices patients should have within the NHS – ranging from choosing a GP practice to accessing treatment in other countries. In addition to signposting reliable and updated healthcare information for patients, the framework also explains what patients should do if they are not offered these choices (e.g. to whom they can report it).2

SDM was also embedded into the NHS Comprehensive Model of Personalised Care, which encourages both patients and healthcare providers to include patient self-management and informed decision-making in personalised care.3 The model is currently being implemented across a third of England, with the aim of reaching 2.5 million people by 2023 and 5 million people by 2033.13

 

Next steps

The National Institute for Health and Care Excellence (NICE) is developing a guideline on SDM, which will outline recommendations for implementing SDM in clinical practice. Publication is expected in April 2021.14

Future implementation targets for SDM through the NHS Comprehensive Model of Personalised Care include:

  • embedding SDM into education and training for all GPs by 2019/20
  • training at least 75,000 clinicians in SDM and personalised care using an interactive training programme by 2023/24
  • using SDM to reduce the use of low-value procedures in 30 clinical situations, including chemotherapy in the last year of life.3

Further information

References:

  1. Department of Health and Social Care. 2010. Equity and excellence: Liberating the NHS. London: Department of Health and Social Care
  2. Department of Health and Social Care. 2016. The NHS Choice Framework: what choices are available to me in the NHS? London: Department of Health and Social Care
  3. NHS England. 2019. Universal personalised care: implementing the comprehensive model. London: NHS England
  4. Coulter A, Collins A. 2011. Making shared decision-making a reality: no decision about me, without me. London: The King's Fund
  5. Charles C, Gafni A, Whelan T. 1997. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 44(5): 681-92
  6. Kehl KL, Landrum MB, Arora NK, et al. 2015. Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care. JAMA Oncol 1(1): 50-58
  7. Mulley A, Trimble C, Elwyn G. 2012. Patients' preferences matter. London: The King's Fund
  8. Park A, Curtice J, Thomson K, et al. 2009. British social attitudes: the 25th report. London: National Centre for Social Research
  9. Dixon A, Robertson R, Appleby J, et al. 2010. Patient choice: how patients choose and providers respond. London: The King's Fund
  10. Department of Health and Social Care. 2012. Liberating the NHS: No decision about me, without me - government response to the consultation. London: Department of Health and Social Care
  11. NHS England. Making shared decision making happen - the common challenges. Available here: https://www.england.nhs.uk/shared-decision-making/making-shared-decision-making-happen-the-common-challenges/ [accessed: May 2019]
  12. Department of Health and Social Care. 2010. Liberating the NHS: greater choice and control - consultation on proposals. London: Department of Health and Social Care
  13. NHS. 2019. The NHS long term plan. Leeds: National Health Service
  14. National Institute for Health and Care Excellence. Shared decision making. Available here: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making [accessed: April 2019]