SHARED DECISION MAKING AND AN EVIDENCE BASED APPROACH

Choosing wisely (UK) refer to “Shared decision making” as the process which promotes the most effective conversations between patients and clinicians defining it as:
 “A collaborative process in which doctors and healthcare professionals work together with patients to select tests, treatments and care management or support packages, based on clinical evidence and patients’ informed preferences and values. It explicitly acknowledges the fact that there is usually more than one way to treat a problem, including ‘no treatment’ and patients may require help to weigh up the benefits and risks of the options in order to determine the best choice for them. There is good evidence that shared decision making benefits patients, improving the quality and appropriateness of clinical decision making.”
“Shared decision making.” Choose Wisely UK website. Retrieved 7th March 2023.

The focus of Choosing Wisely UK is about shared decision making, using BRAN to encourage patients to get the best from conversations with their healthcare professional by asking four questions for any investigation or treatment.

1. What are the Benefits?
2. What are the Risks?
3. What are the Alternatives?
4. What if I do Nothing?

“More doesn’t always mean better: Helping you and your doctor make the right decisions about your care” Choose Wisely UK website. Retrieved 7th March 2023.

From the Academy of Royal Medical Colleges
Choosing Wisely UK BRAN patient leaflet CWUK_patient_leaflet_100120.pdf

More information on shared decision making

There is much more information on shared decision making and how it can benefit your care under

• Shared Decision Making

Some simple examples of evidence based care

Importantly these examples are just for information and should only be used in a discussion with a clinician and are not a substitute for medical advice or treatment. In addition, as explained in the articles sometimes these tests are required, so the support of a clinician is helpful.

From NICE
There are many examples, but these are just four to illustrate when a test might not be needed:

• A vitamin D blood test: “Note: asymptomatic people at higher risk of vitamin D deficiency do not need routine testing for vitamin D deficiency, but should be advised on the need for maintenance dose vitamin D supplementation.” Diagnosis | Diagnosis | Vitamin D deficiency in adults | CKS | NICE
• Menopause blood tests: “Do not routinely use blood tests such as follicle-stimulating hormone (FSH) measurements to diagnose perimenopause or menopause in otherwise healthy women (who are not using hormonal contraception) aged over 45 years, with typical menopausal symptoms.” Diagnosis of menopause and perimenopause | Diagnosis | Menopause | CKS | NICE
• Cellulitis swabs: “Investigations are not usually necessary but may be considered in certain cases…” Diagnosis | Diagnosis | Cellulitis – acute | CKS | NICE
• Neck Pain X-rays: “Cervical X-rays, and other imaging studies and investigations are not routinely required” Assessment | Diagnosis | Neck pain – non-specific | CKS | NICE

What is important from these examples from NICE is not whether you have a test but that you work together with your clinician “to select tests, treatments and care management or support packages, based on clinical evidence and patients’ informed preferences and values.” Links to NICE guidance throughout this web site often provides information on when and what tests should be done.

more detailed examples of evidence based care

From the Academy of Medical Royal Colleges
Their page on evidence-based interventions includes a number of examples of when tests and treatments may offer little value. Home – EBI

From Choosing Wisely Australia
Choosing wisely is an international initiative, including Australia. There may be some variation of evidence based care across countries so you should not rely on any recommendation but first discuss any choice with your clinician.
Though these are intended for clinicians many recommendations will be similar in the UK as for example, some of the recommendations from the Australasian Society for Infectious Diseases.
Recommendations Recommendations – Choosing wisely

False positive tests

This refers to the situation where a blood test wrongly indicates a potential abnormality. This is not common but explains why clinicians and patients together should always justify each blood test been done. When a test shows a potentially significant abnormality it will need to be repeated, wasting patient’s time and potentially causing some unnecessary anxiety, if there was no real value in doing the blood test in the first place.

An example of a false positive can occur with a raised potassium:

From the Mayo Clinic
High potassium (hyperkalaemia) High potassium (hyperkalemia) Causes – Mayo Clinic