Engaged and informed patients:The potential of shared decision making

………a King’s Fund Conference

October 2010

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

2

The problem

• People want more involvement in decisions about their health care• A priority for 10 years, but little evidence of progress• In a “cold” financial environment there’s greater focus on

unwarranted variation and the possibility that the NHS is “over-producing”

………shared decision may assist with these challenges

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

3

A definition

“Supporting individuals so that they may make rational health and medical decisions based on a consideration of benefits and risks (for them)………….and their values and

preferences.”

Dr Steven Laitner

National Clinical Lead

…..but the concept is many centuries old

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

4

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

5

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

6

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

7

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

8

Decision aids reduce rates of discretionary surgery

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

9

Decision aid + coaching in gynaecology

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

10

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

11

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

12

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

13

The collaboration between doctors and patients can be improved

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

14

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

15

Patient criteria for web-based interventions

• A single, trustworthy site – few external links• Easy navigation• Attractive presentation; tone & voice important• Information

Detailed, specific, practical, regularly updatedUser controls access to information

• Range of interactive facilities includingChat rooms/forumsQ & AFormal behaviour change and decision support

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

16

Data from systematic reviews

They can “work” ie they can improve users’• Knowledge• Self-efficacy• Intentions• Perceived social support• Mood• Health behaviours• Clinical outcomes

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

17

But there’s still a lot we don’t know

• How they work• Who they work for• What health problems do they help with• How to encourage people to use them• How to integrate them into routine NHS care

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

18

Patient decision aids already commissioned

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

19

Integrated tools and approaches

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

20

Some “quotes”

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

21

Some key themes

Outpatients is an 18th century model of healthcare delivery• Our health system is too “hospital centric” – there’s a need to

• Destabilise hospitals

• Get hospital consultants reconnected with their communities

Issues of health literacy apply to patients and clinicians - particularly statistical information• There’s a need for a customised approach that’s appropriate for different sub-populations

• The value of patient to patient experiences (and stories)

And• Don’t put decision tools out their passively – it’s the support and processes that surround the web resource that makes the difference

• Identify the “decision window”

Bet

ter,

so

on

er,

mo

re c

on

ven

ien

t

22

Three simple components• Self care • Guidelines – these should be for patients• The veto rule – help people to say no

“The NHS needs new entrants to trigger disruptive change”

The focus should be on shared decision making as a clinical activity, not on decision aids………clinicians need support to change

People with long term conditions are the ultimate decision makers and risk takers

………should they be called punters rather than patients?