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Online Learning Series Right Care for Populations Embedding Shared Decision Making in Routine Care Dr Steven Laitner @SteveLaitner ©2011 the Strategic Projects Team Part of the Strategy & Policy Directorate What is Shared Decision Making Shared decision-making is a process which involves Patients: • as active partners with their clinician; • in clarifying acceptable medical options; • and in choosing a preferred course of clinical care. ©2012 Copyright notice Reference or date What are they sharing? Clinicians Patients • • Diagnosis Diagnosis Cause of • • Cause of disease disease Prognosis • • Prognosis Treatment options • • Treatment options • Outcome probabilities • Outcome probabilities • • • • • ©2012 Copyright notice Experience of illness Social circumstances Attitude to risk Values Preferences Reference or date Wanted more involvement in treatment decisions: % Source: NHS inpatient surveys ©2012 Copyright notice Reference or date Choice of Modality 20% 38% • ©2012 Copyright notice Reference or date Some quotes from our Service User Reference Group “recognise the “patient” as an expert in themselves” “listen to us” “don’t only concentrate on the clinical” “be aware that management of the LTC is only a small part of my life” “I want to be seen as a whole person” (ortho example) “stop using language and knowledge as a barrier” “speak to me with respect” 6 Consensus about evidence / necessity 10x 2x Importance of patient preferences ©2012 Copyright notice Reference or date Variation in UK ©2012 Copyright notice Reference or date Risk Groups and Survival Low Risk (33.5%) Medium Risk (56.7%) High Risk (8.9%) Chandna SM et al. Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity. BMJ 1999; 318 : 217223. ©2012 Copyright notice Reference or date Decision Aids reduce rates of discretionary surgery RR=0.76 (0.6, 0.9) O’Connor et al., Cochrane Library, 2009 ©2012 Copyright notice Reference or date Why shared decision making? The benefits are: • Improving patient satisfaction, experience, knowledge; • Helping patients make healthcare choices aligned with their personal needs, values and circumstances; • Improving clinical outcomes and safety; • Achieving the right intervention rate and reducing unwarranted practice variation; • Reducing cost and litigation costs. ©2012 Copyright notice Reference or date The National SDM Programme ©2012 Copyright notice Reference or date Totally Established Kidney Disease (x 3) Cataracts AAA Repair Pregnancy after c-section Depression AAA Screening Osteoarthritis Hip Osteoarthritis of the knee BPH (LUTS) PSA Testing Localised Prostate Cancer Menorrhagia Rheumatoid Arthritis Blood pressure COPD Carpal tunnel syndrome Atrial Fibrillation Stable angina Serous Otitis Media Sciatica Inguinal Hernia Recurrent Tonsillitis Acne Localised Bladder cancer Type 2 NIDDM (x 2) Cholecystitis Localised Lung cancer Smoking cessation Obesity Localised Breast Cancer Cholesterol Amnio/CVS ©2012 Copyright notice Reference or date ©2012 Copyright notice Reference or date ©2012 Copyright notice Reference or date ©2012 Copyright notice Reference or date “Give people the care they need and no less; the care they want and no more” Al Mulley [email protected] Twitter: @SteveLaitner ©2012 Copyright notice Reference or date Since March 2013, the national shared Decision Making Programme is being run by the NHS England Patients and Information Directorate. You can find out more about the SDM programme at the NHs Networks site here: http://www.networks.nhs.uk/nhs-networks/shared-decisionmaking-sdm The Patient Decision Aids can be found here: http://sdm.rightcare.nhs.uk/ ©2012 Copyright notice Reference or date Online Learning Series Right Care for Populations Find the full series at: www.rightcare.nhs.uk/resourcecentre 19 Follow Right Care online • Subscribe to get a weekly digest of our blog alerts in your inbox, • Receive occasional eBulletins • Follow us on Twitter @qipprightcare