Guest Editorial May 2011
The guest editorial for May was written by Professors Glyn Elwyn and Richard Thomson, who presented on the topic of MAGIC - MAking Good decisions In Collaboration during the Expert on Call on 19th May 2011. Follow this link to listen to a recording of the session.
Shared decision making - what is it? Are you already doing it? What are the challenges for implementation in practice?
If you are involved in treating patients, managing or improving health services or managing or training those that do, you will have heard the term shared decision making? It is an approach to providing care for patients that will become increasingly important – so it is best to be clear about what it is, and how best to achieve it in practice.
Often in clinical practice, there is more than one way to manage a problem and it is not always clear whether one way is better than another. In these situations, the views, or we like to say, the preferences, of the patient and their relatives, becomes very important.
Shared decision making becomes highly relevant in these situations because it is an approach where clinicians and patients communicate together using the best available evidence when faced with the task of making decisions, where patients are supported to think about the possible attributes and consequences of options (what is important to them), in order to arrive at informed preferences. There are some situations of course where patients do not want to take part in such an approach, or where it is impossible to do so. Those situations are however rare.
A good example would be the situation that many women face when diagnosed with early breast cancer. Treatment can involve mastectomy or breast conserving surgery coupled with radiotherapy. The survival for either approach is the same. However, there are other implications. Women with breast conserving surgery have a higher rate of recurrence, but avoid loss of their breast. Those with mastectomy may feel reassured that the breast has been fully removed. Surgeons, radiologists and breast cancer nurse specialists can support women in making the right decision by providing accurate and understandable information on the risks and benefits of the options. But it is the individual woman who best understands what is important to her in this choice; clinicians can help a woman explore that, but the woman must have a central role in decision-making. Bresdex is a tool that has been designed to support this discussion, see http://www.bresdex.com/
Many clinicians have of course been involving patients in decisions throughout their career and so this is not a radical or new idea. However, there is considerable evidence that it is possible to improve on current practice by using skills and tools that are shown to be of benefit to patients.
Developing tools that help summarise information about treatment options helps both patients and clinicians communicate clearly when they meet face to face. More extensive information can be used by patients and their families, either before or after they meet. These can be leaflets, DVDs or websites and the NHS in the UK is piloting the use of such tools in 2011.
There are many potential benefits that come from shared decision making. It has been proven that patients’ knowledge increases significantly – so that is the first and most obvious gain. It seems that more informed patients are better able to understand the risks of treatments, less likely to be undecided, and more likely to make decisions consistent with their values. In some situations, this means that patients decide to be more cautious about the treatments they agree to have, or tend to wait a bit longer to see whether things improve over time. There are many people who think that a better informed patient is less likely to complain that they were not told about important issues that they might face and that they are better able to make sure they spot errors and take action. These benefits are significant, hence the increasing interest in shared decision making.
MAGIC stands for MAking Good decisions In Collaboration and it is a programme of work in Newcastle and Cardiff, funded by the Health Foundation. It is led by Professors Glyn Elwyn and Richard Thomson, and is studying how best to put shared decision making into practice. This webinar will be an opportunity to share some of the learning with a wider audience.
Professor Glyn Elwyn
email: elwyng@cardiff.ac.uk
http://medicine.cf.ac.uk/en/person/prof-glyn-elwyn/research/
Professor Richard Thomson
email: richard.thomson@ncl.ac.uk
http://www.ncl.ac.uk/ihs/people/profile/richard.thomson
URL: http://www.health.org.uk/areas-of-work/improvement-programmes/shared-decision-making/
