Health Support

Shared Decision Making

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What is shared decision making?

As NHS England suggests
“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 and what the patient knows best: their preferences, personal circumstances, goals, values and beliefs.”
“Shared decision making.” NHS England website. Retrieved 18th January 2023

This is explained further below:

Benefits

As NICE suggest about the benefits

  • It allows people to discuss and share information. This makes sure people have a good understanding of the benefits, harms and possible outcomes of different options.
  • It empowers people to make decisions about the treatment and care that is right for them at that time. This includes choosing to continue with their current treatment or choosing no treatment at all.
  • It allows people the opportunity to choose to what degree they want to engage in decision making. Some people prefer not to take an active role in making decisions with their healthcare professionals.
    “Shared decision making.” The NICE website. Retrieved 13/2/2024
    Shared decision making | NICE guidelines | NICE guidance | Our programmes | What we do | About | NICE

As the Patient Association suggest
Studies have shown when people are involved in decisions:

  • They have fewer regrets
  • They report better relationships with health and care professionals
  • Decisions are made more effectively
  • Their health outcomes improve
    “Shared decision making.” The Patients Association website. Retrieved 13/2/2024
    Shared decision making | The Patients Association

What does shared decision making mean for you?

As the Patient association suggest
“Shared decision making takes into account what matters to you.

  • Different choices will be discussed
  • They will be explored in full, including the risks and benefits
  • Your needs and preferences will be taken into account
  • You will reach a joint decision with health and care professionals about what is best

Your health or care professional should take the time to explain your options. They should listen to your views and concerns.”
Shared decision making | The Patients Association

3 simple questions to start with

There are 3 simple questions you can start with when thinking about your options (choices).

  1. What are my options?
  2. What are the possible benefits and risks of those options?
  3. What help do I need to make my decision?

An easy read version of these questions are provided by the NHS Knowledge and Library Services
Easy read patient leaflet 3 questions for better health

These simple questions can be expanded for any investigation or treatment

4 shared decision-making questions to ask

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?

From Choosing Wisely UK
Downloadable patient leaflet which explains this all in more detail Choosing Wisely UK – Choosing Wisely UK

Further questions you can ask

These simple questions are a very good place to start, but there may be more questions you want to ask. Also there may be questions you want to ask yourself before you attend the appointment and also after your appointment. The good news is there are a number of lists of questions provided by other organisations which you can look at and can give you ideas.

The NHS provides a simple list of questions you can think about and decide if you want to ask

NICE also provide questions to think about before your appointment

From the Patient Association
Make the most of your GP appointment, includes some tips to help with your appointment Make the most of your GP appointment | The Patients Association

How shared decision making works depends on what you want

As NICE suggest
“You can be as involved as you want to be in making decisions. You need to know what your options are and the positives and negatives of them. This information must be easy for you to  understand. Your health or social care practitioners need to know what matters to you. No two people are the same and they should listen carefully to your views and concerns.”
Your care | Making decisions about your care | NICE and the public | NICE Communities | About | NICE

As the patient association suggest
“Your health or care professional should take the time to explain your options at your appointment but you may want to find out.”
Shared decision making | The Patients Association 

However you may also wish to learn about your options before your appointment or read up more information after you appointment.

Why might you want to understand something about your options before your consultation?

At your appointment the health care professional will do their best to share as much information as they can about your condition but are constrained by the length of a consultation (usually around 10 minutes even though your clinician will take longer if possible). Having some knowledge of the subject allows you to ask more detailed questions and also helps you clarify understanding during the consultation rather than later thinking of the question you wanted to ask.

How can you find good Evidence based knowledge about your options?

A simple place to start is to use the links on this website, for many common conditions. For each condition these links to other websites can help you understand the condition better, understanding the options available and when they may be relevant to you. In addition using this website there are links to help you navigate the system to achieve some of these options including potentially self-care, local self-referral and support for your condition from a national helpline if relevant to you.

If the information you want is not available you can use some of the links to the NHS, Patient info and NICE websites which are explained under

There are other good websites and also symptom checkers some of which can be found under

If you want to understand how much evidence there is for some of the options suggested then a website which looks more closely at the evidence can help, such as Evidently Cochrane.

From Evidently Cochrane
“aims to make Cochrane evidence really accessible, and to encourage discussion about it, through blogs which usually feature new or updated Cochrane reviews on a health topic.” This covers the latest evidence available on many health topics.
Home Evidently Cochrane – Sharing health evidence you can trust

Finally you may want to look at some of the information your health care professional will look at when discussing your options with you. They will generally look at the evidence from the National Institute for Health and Care Excellence (NICE).

From NICE

Patient Decision Aids (decision support tools) can also be used when available

Patient Decision Aids (PDAs) offer another possible way of considering the different options you may be thinking about. PDAs are covered in detail on a section on this page.

Personalised care and long-term conditions

As the Department of Health suggests for people with long term conditions
“Personalised care planning is essentially about addressing an individual’s full range of needs, taking into account their health, personal, family, social, economic, educational, mental health, ethnic and cultural background and circumstances. It recognises that there are other issues, in addition to medical needs, that affect a person’s total health and well-being.”
“Care coordination: improving care for people with long term conditions.” The Gov UK website. Retrieved 8th February 2024.

Support for a person with a long term condition needs to be broader than just focusing on medical needs but also involves considering what matters to them in supporting their overall wellbeing. There is information on how some important non-medical needs can be supported locally under

The My Planned Care NHS website provides information on what you might want to ask at a hospital appointment. The website also provides information from local hospitals on operations they do, so you can ask questions about any operation at your appointment.

From My Planned Care
“My Planned Care gives you advice and support while you wait and helps you to prepare for your hospital consultation, treatment, or surgery. This includes giving you information about waiting times at your hospital and other supporting and local services while you wait.” My Planned Care NHS
Includes

PATIENT EXPERIENCES

It can on occasions be helpful to understand other people’s experience of the health condition you have.

From Health Talk
“Thousands of people have shared their experiences on film to help you understand what it’s like to have a health condition such as breast cancer or arthritis” Healthtalk

From Health Unlocked
“The world’s largest social network for health” Free Membership
“A social network that allows users the chance to connect with others going through the same thing as them. By engaging with one of hundreds of specialised communities, users can get advice, support or simply chat with people who understand their perspective and can offer some new insight by giving their own.” HealthUnlocked | The social network for health

Further information

From NHS England
Shared decision making NHS England » Shared decision making

Choosing Wisely UK

From the Patient Association
Shared Decision Making Shared decision making | The Patients Association 

From the NHS 

From NICE

From the Royal College of General Practitioners
Shared Decision Making Person-Centred Care toolkit: Shared Decision Making | RCGP Learning

Easy read information

On the easy read page, in the section on “support in any NHS appointment” there are links to easy read patient leaflets which can help explain shared decision making and support in any health appointment, see under

  • Easy Read Information –  Note: there is also other information on this easy read information page which may help with shared decision making.

View and understand your GP health record

Understanding your own health better, including any medication you are taking, any tests you have had and any long term conditions you might have can help you with your decision making.

From the NHS
View your GP health record including your medical notes, test results, repeat medication, vaccinations and more View your GP health record – NHS

There is support to help you understand different parts of your GP health record including:

The NHS account is explained in more detail below:

AN NHS ACCOUNT

From the NHS
“Getting started with your NHS account” includes “Find out who can have an NHS account to use the NHS App or NHS website to access certain NHS services – and how to set up your account, log in and prove who you are to get full access.” Getting started with the NHS App – NHS App help and support – NHS

FURTHER INFORMATION ON THE ADVANTAGES OF AN NHS ACCOUNT

There is more information on your NHS account including many other functions beyond just online access to your test results under

Patient Decision Aids

Patient Decision Aids (decision support tools) should be seen as a potential extra possible tool to support shared decision making in any health consultation (practice or hospital).

As NICE suggest
“Patient Decision Aids (PDAs) help people decide on healthcare options. They provide evidence-based information on the options available, along with likely outcomes, benefits, harms and uncertainties. They should be used to inform conversations between a person and their healthcare professional, supporting them to make informed choices in line with their personal values and preferences.
“Patient decision aids.” NICE website. Retrieved 12th February 2024.
Patient decision aids | Making decisions about your care | NICE and the public | NICE Communities | About | NICE

At present the majority of PDAs are produced outside the UK, such as the USA, but there are some helpful PDAs now used in the UK and the number is likely to increase over time.

Patient decision aids often pose questions which you might want to ask or a GP might ask of you (providing answers to these possible questions). They should only be used with a clinician so you should not rely on them on your own to make decisions.

UK PATIENT DECISION AIDS (pda)

Patient decision aids should be seen as a potential extra tool to support “discussing risks, benefits and consequences in the context of each person’s life and what matters to them.”
“Recommendations.” NICE website. Retrieved 18th January 2023
Recommendations | Shared decision making | Guidance | NICE)

PDAs should only be used with a clinician so you should not rely on them on your own to make decisions.

Examples of Patient Decision Aids

From the Personalised Care Institute
Include decision aids produced by NHS England and the Winton Centre for Risk and Evidence Communication (University of Cambridge)
Decision Support Tools Decision Support Tools

From NICE
A complete list of NICE patient decision aids (PDAs) which may be used in hospital and general practice Patient decision aids | Making decisions about your care | NICE and the public | NICE Communities | About | NICE
The ones relevant in general practice are listed below:

From Patient info
Cardiovascular Health Risk Assessment Cardiovascular Health Risk Assessment | Patient

From Clinrisk
For a better understanding of cardiovascular risk

  • Welcome (about) Welcome
  • Details on and links to Qrisk 3 and Qrisk 2 cardiovascular calculators QRISK3
  • Details on Qintervention 2017 QIntervention

From NHS England
Includes PDAs already listed, however this page may be added to in the future so has been included.
Decision support tools NHS England » Decision support tools

NON – UK PATIENT DECISION AIDS (pda)

Remember, importantly as Ottawa Hospital Research Institute suggest about PDAs
“They are designed to complement, rather than replace, counselling from a health practitioner.” Patient Decision Aids – Ottawa Hospital Research Institute

PDAs should only be used with a clinician so you should not rely on them on your own to make decisions.

Note: the websites below are from outside the UK so some drug and service information will differ from the UK but the underlying principles are similar.

From Ottawa Hospital Research Institute
Provides a list of patient decision aids by condition and topic from other organisations. It also measures each PDA against set criteria to demonstrate their validity. Note: as the list includes many American websites some drug and service information may be different from the UK. 

From the Mayo Clinic
Note: as an American website some drug and service information may be different from the UK.
Mayo Clinic Shared Decision-Making National Resource Center Mayo Clinic Shared Decision Making National Resource Center – care that fits
Tools in SDM Tools – care that fits

Further information

From Patient info
Decision Aids Decision Aids | Doctor | Patient

From NICE
NICE decision aid: process guide NICE decision aid: process guide | Guidance | NICE

Videos and podcasts

On the videos and podcasts page there are links to some relevant videos and podcasts covering the topic of shared decision making.

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