Transcript The Right Care Shared Decision Making Programme

The Right Care Shared Decision Making Programme
Dr Steven Laitner
GP and National Clinical Lead for Shared Decision Making
What is shared decision making?
Shared decision-making is a process in which
patients are:
involved as active partners with their clinician
in clarifying acceptable medical options
and choosing a preferred course of clinical
care.
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What are they sharing?
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Clinicians
Patients
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Diagnosis
Cause of disease
Prognosis
Treatment options
Outcome probabilities
Experience of illness
Social circumstances
Attitude to risk
Values
Preferences
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Why?
Wanted more involvement in treatment decisions:
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Source: NHS inpatient surveys
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Knee replacement satisfaction
• Satisfaction questions were completed by
8095 patients
• Overall
81.8% were satisfied
11.2% were unsure
7.0% were not satisfied
• The OKS varied according to patient
satisfaction (p<0.001)
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Variation in UK
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Hip Replacement
When analysed by PCT
boundary, the variation in
rates of expenditure for
cemented primary hip
replacement per 1000
population is 16-fold.
The rate of expenditure for
uncemented primary hip
replacement per 1000
population also varies
substantially among PCTs at
greater than 30-fold
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Rate of anterior cruciate ligament reconstruction
expenditure per 1000 population by PCT Weighted by
age, sex, and need; 2008/09
The variation among PCTs in the rate
of expenditure for anterior cruciate
ligament reconstruction per 1000
population is 50-fold.
in Sweden, reported in the New
England Journal of Medicine, where it
was found that:
“a strategy of rehabilitation plus early
cruciate ligament repair was not
superior to a strategy of rehabilitation
plus optional delayed reconstruction.
The latter strategy substantially
reduced the frequency of surgical
reconstructions”.1
1. Frobell RB et al. New England Journal of
Medicine 2010: 363; 386-388.
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Variation in knee replacement activity
Top 30 PCTs
(Lowest Rates)
London
Next 31 PCTs
Next 30 PCTs
Next 31 PCTs
Bottom 30 PCTs
(Highest Rates)
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A New Paradigm for Demand Management?
Supporting individuals so that they may make
rational health and medical decisions based on a
consideration of benefits and risks (for
them!)………
…and their values and preferences
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Decision Aids reduce rates of
discretionary surgery
RR=0.76 (0.6, 0.9)
O’Connor et al., Cochrane
Library, 2009
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The policy context
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Commissioning for Value
QIPP | Right Care
RIGHT CARE FOR POPULATIONS
NHS Atlas of Variation
Population Planning and Programme Budgeting
Accountable Integrated Systems of Care
RIGHT CARE FOR PATIENTS
Shared Decision Making
NHS Direct Patient Decision Aids
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Patient Comments:
"All the necessary information was there in simple illustrative
manner"
“Easy to follow and explained in simply in plain English“
“I have an understanding of what I want to get across to the
consultant”
"Own time, own space, own pace"
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Patient Decision Aids
Phases 1 - 3
Phase Healthcare Decision Addressed by the Patient Decision Aid
Current Status or Expected Launch Date
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Osteoarthritis of the knee
Rolled-out since February 2011
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BPH
Rolled-out since February 2011
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Localised prostate cancer
Rolled-out since February 2011
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Breast cancer surgery choices
Rolled-out since August 2011
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Chorionic villus sampling/amniocentesis
Rolled-out since August 2011
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Prostate Specific Antigen (PSA) testing
Rolled-out since August 2011
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Osteoarthritis of the hip
Rolled-out since August 2011
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Cataract surgery
Rolled-out since August 2011
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Advanced kidney disease (end of life care plan)
Autumn 2011 -launch date TBC
www.nhsdirect.nhs.uk/en/DecisionAids
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Patient Decision Aids
To be developed over the next 24 months
Healthcare Decision Addressed by the Patient Decision Aid
• Abdominal aortic aneurysm screening and repair
• End stage renal failure
• Multiple sclerosis
• Serous otitis media
• Sciatica
• Chronic obstructive pulmonary disease (COPD)
• Stable angina
• Inguinal and umbilical hernia
• Cholecystitis acute or recurrent
• Non insulin dependent diabetes
• Carpal tunnel syndrome
• Menorrhagia/ menstrual disorders
• Recurrent tonsillitis
• End of life care
• Atrial fibrillation
• Obesity
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Key messages
• Patients want to be more involved in
decisions about their healthcare
• Doctors and nurses need to work better with
patients to share the decision-making
process. This requires a culture change
• Decision aids and decision support help
patients make healthcare decisions which are
right for them and right for society
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Thank you
Give people the care they need and no less,
the care they want and no more
[email protected]
www.rightcare.nhs.uk
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