Shared decision making (SDM) ensures that individuals are supported to make decisions that are right for them. It is a collaborative process through which a clinician supports a patient to reach a decision about their treatment.
The conversation brings together:
the clinician’s expertise, such as treatment options, evidence, risks and benefits
what the patient knows best: their preferences, personal circumstances, goals, values and beliefs.
Hampshire and Isle of Wight are working with their partners in Acute Hospital Trusts to embed Shared Decision making across hospital pathways; work on these programmes will be shared here.
Solent NHS Trust provides a community musculoskeletal service that assesses and manages all local primary care musculoskeletal referrals. As part of this, patients have access to clinical specialist physiotherapists who offer specialist assessment, diagnostic investigations, and management including interventions such as physiotherapy and joint injections, or a referral to secondary care for a surgical opinion.
The aim is to achieve the most appropriate management for the patient based on their clinical presentation, values, and patient preferences. Shared decision making (SDM) is a vital process to achieve this outcome. The team undertook a service evaluation to learn how well SDM is incorporated into the consultations as part of hip and knee osteoarthritis management.
The team evaluated 51 patients’, using the collaboRATE tool, which asks 1) How much effort was made to help you understand your health issues? 2) How much effort was made to listen to the things that matter most to you about your health issues? 3) How much effort was made to include what matters most to you in choosing what to do next? Answers were via a 0-9 scale, where 0 meant ‘No effort was made’ and 9 meant ‘Every effort was made’. There was also an opportunity for patients to give feedback and suggestions on SDM.
Overall, the results showed SDM was being done well, with 51% of patient scoring 9 out of 9. The team were pleased with the results considering that none of the clinicians had any prior training of SDM.
The findings were shared with the team in an Action Learning Set. This created peer discussion on establishing what SDM is to us as a service, what it isn't and how can we implement it better. Darren commented ‘I think some clinicians struggle with what SDM actually is, because in the past we have used decision aids (options grids), and some people felt that was SDM. Importantly for me it is, ‘what matters to you?’ rather than, ‘what is the matter with you?’
The team also changed some of their systems, by putting in key questions around ‘What matters to you?’, expectations and concerns as part of the history taking assessment. They are also going to obtain formal training to help embed SDM in the service.
For Guto being part of this project has supported his studies and he felt ‘SDM seems like a logical thing to do and ethically it's the right thing to do, with so many benefits. More doctors need to know about SDM and personally everything I have learnt I will bring into the care I provide’.
SDM can support better patient outcomes and care, whilst provide clinician satisfaction. Darren said ‘the greatest benefit is the interaction with your patient, as you feel you are on the same page and working with them rather than parentally telling them. Effective SDM is more likely to get better outcomes ‘.
For the orthopaedic triage team evaluating, discussing the finds, and making changes together as team, provided a better understanding of SDM to them. By working together on ‘What matters to you?’ they feel this will improve the way they personalise care within their service.