Shared Decision Making (SDM) is part of the NHS Long Term Plan’s commitment to make personalised care business as usual across the health and care system.
People want to be more involved in decisions about their health and care.
SDM ensures that people are supported to be as involved in the decision making process as they would wish. SDM means people are supported to:
- understand the care, treatment and support options available and the risks, benefits and consequences of those options
- make a decision about a preferred course of action, based on evidence based on good quality information and their personal preferences.
It is, therefore, a process in which clinicians and individuals work together to select tests, treatments, management or support packages, based on evidence and the individual’s informed preferences.
SDM is relevant in any non-life threatening situation when a health or care decision needs to be made and a range of options (including doing nothing) is available.
SDM ensures that individuals are supported to make decisions based on their personal preferences and are, therefore, more likely to adhere to evidence based treatment regimes, more likely to have improved outcomes and less likely to regret the decisions that are made.
By paying attention to individuals’ informed preferences we can support people to achieve outcomes that matter to them. Aggregating the decisions of informed individuals to a population level means we can commission and provide services that informed people want and therefore allocate resources more efficiently.
There are some decision making aids from NHS England and other health and care partners for specific conditions including Atrial Fibrillation, type 1 diabetes and more:
Why is SDM important?
- It can create a new RELATIONSHIP between individuals and professionals based on partnership (Mulley et al, 2012)
- People want to be more INVOLVED than they currently are in making decisions about their own health and health care (Care Quality Commission Inpatient Survey, 2019; NHS England, GP Patient Survey, 2020)
- Both individuals and clinicians tend to consistently OVERESTIMATE the benefits of treatments and UNDERESTIMATE the harms (Hoffman, 2017)
- It has the potential to ENHANCE allocative efficiency and REDUCE unwarranted clinical variation (Mulley et al, 2012)
- It is intrinsic in PROFESSIONAL CODES of conduct/standards (General Medical Council, 2020; Nursing and Midwifery Council, 2018) (Health and Care Professional Council, 2018)
- It is a LEGAL requirement and health professionals now must take “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment and of any reasonable alternative or variant treatments”. (Health and Social Care Act 2012, Medical Protection Society, 2015; Montgomery v Lanarkshire Health Board, 2015)
Shared Decision Making Implementation Model
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View or download the Shared Decision Making Implementation Model (pdf)
Clinical Codes
The following clinical codes exist for SDM and all primary care clinicians can use them, SNOMED are the preferred option. The benefit of coding in this way is that you can understand how many SDM conversations are taking place within your organisation and the process by which that conversation took place.
SNOMED:
815691000000107 | Shared decision making
815751000000108 | Shared decision making with decision support (procedure)
815711000000109 | Shared decision making with patient decision aid (procedure)
815791000000100 | Shared decision making without decision support (procedure)
815731000000101 | Shared decision making without patient decision aid (procedure)
NICE documentation to support Shared Decision Making
NICE shared decision making information can be found by clicking this link Shared decision making | NICE guidelines | NICE guidance | Our programmes | What we do | About | NICE.
NICE have created some patient decision making aids, which you may find useful Patient decision aids | Making decisions about your care | NICE and the public | NICE Communities | About | NICE