National commitment to shared decision makingBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4746 (Published 20 October 2017) Cite this as: BMJ 2017;359:j4746
- Gillian Leng, deputy chief executive1,
- Celia Ingham Clark, medical director for clinical effectiveness2,
- Kate Brian, women’s voices lead3,
- Gemma Partridge, national medical director’s clinical fellow1
- 1National Institute for Health and Care Excellence, London, UK
- 2NHS England, London, UK
- 3Women’s Network, Royal College of Obstetricians and Gynaecologists, London, UK
- Correspondence to: G Leng
NICE and NHS England are working with the Shared Decision Making Collaborative to encourage shared decision making in England.1 The collaborative, established in 2015, brings together over 40 individuals and organisations with a commitment to work to promote shared decision making in UK health systems, drawing on national and international expertise. Its broad ambition is to make shared decision making the norm through clinical education, by making effective patient decision aids available, and by raising people’s expectations of having an active role in determining the best care for them based on their values and preferences.
NICE is committed to developing decision aids based on clinical guidelines, and NHS England is committed to embedding shared decision making in its strategic and practical developments. NICE will also be developing a guideline on shared decision making to provide practical, evidence based recommendations for clinicians and patients, facilitating better conversations about healthcare options. These guiding principles for use across all healthcare will be strengthened by the production of specific decision aids to inform discussion about what individuals consider important.
Most clinicians support the idea of person centred care as a model of best practice, yet we know from published research and NHS patient surveys that people still want to be more involved in decisions about their healthcare.2 In shared decision making, healthcare professionals support individuals to make informed decisions about investigations, referrals, and management. The information given should be based on the best available evidence of the likely benefits, risks, and outcomes of the various treatment options, with the individual’s values and preferences being central to the decision.
Clinicians’ attitudes to shared decision making often show a lack of awareness of its value.3 Reported comments refer to lack of time or incentives to use shared decision making and a belief that it is inappropriate for people with low health literacy, that it might prompt demand for inappropriate or expensive treatments, and that people would prefer to be given a definitive treatment plan.
People who are supported to make an informed decision by a healthcare professional seem to have better outcomes,4 better experiences,5 and less regret6 about their decisions. Much is made of the need to reduce unwarranted variation in healthcare. However, shared decision making can provide context and legitimacy for variation when it results from incorporating people’s values and preferences. Reliably informed, shared decisions lead to informed demand that, when applied across a pathway of care, can influence commissioning and provision of services.
A Cochrane review found that people who use decision aids to support their choice of treatment are more likely to choose less invasive options than those who do not.7 If these findings translate to real world populations shared decision making may have the secondary benefit of saving resources. National programmes such as Choosing Wisely UK,8 Prudent Healthcare in Wales,9 and Realistic Medicine in Scotland10 are designed to ensure value for public money and to prevent waste while further reducing the burden and harm people can experience from overinvestigation and overtreatment. When these programmes are effectively implemented they use shared decision making so that individuals can make informed choices about their care.
In 1998, Cyril Chantler, then chair of the General Medical Council’s standards committee, famously said: “Medicine used to be simple, effective and relatively safe. It is now complex, effective and potentially dangerous. The mystical authority of the doctor used to be essential for practice. Now we need to be open and work in partnership with our colleagues in health care and with our patients.”11 Partnership has progressed slowly since then, and we hope this demonstration of national commitment by NICE, NHS England, and others will accelerate development of truly person centred care throughout the NHS.
Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.