Time for a new relationship – shared decision making at the Royal College of Physicians

In the third in our series of blogs from partners discussing their initiatives,  as shared at our Partners’ Meeting in June 2016, we hear from Ella Jackson of Royal College of Physicians about their work on shared decision making.

Shared decision making requires a collaborative relationship between people and clinicians who work together in an equal partnership to decide on the course of action for treatment. A person’s own preferences, values, experience, and beliefs (the person’s perspective) and the biomedical options and evidence (professional perspective) are both equally relevant to most clinical decision making situations.

The most recent Care Quality Commission Inpatient Survey found that 60 per cent of people surveyed said they were ‘definitely’ involved in decisions about their care ‘as much as they wanted to be’[1]. While this is a promising three per cent increase on the previous year, it remains the case that 40 per cent said they were not.

No decision about me, without me

The slogan ‘no decision about me, without me’ encapsulates that people’s rights to participate in and contribute to their own lives should be recognised and respected. In other words, properly involving people in decisions about their health and care is the right thing to do.

But that’s not the only reason we should be doing it. The evidence suggests that people who have the opportunity and support to make decisions about their care and treatment in partnership with health professionals:

  • are more satisfied with their care[2]
  • are more likely to choose treatments based on their values and preferences rather than those of their clinician[3]
  • tend to choose less invasive and costly treatments.[4]

Some studies of specific decisions about treatment suggest that, shockingly, as many as 30 per cent of people would have made different choices had they been fully informed about the options available and supported to make their own choices about these. Clearly there is plenty of room for improvement in how people are supported to make decisions.

What the RCP is doing

Through our three-year Health Foundation funded programme, the RCP has worked to bring person-centred care – articulated in terms of shared decision making and support for self-management – into mainstream physician and wider clinical practice. We focused on three key areas:

  • influencing NHS culture towards one that values collaboration between clinicians and people
  • supporting doctors to develop the knowledge and skills they need to be able to do shared decision making
  • supporting the system-level change required to facilitate it.

Working with members of the RCP’s Patient and Carer Network throughout our programme, we modelled the partnership approach we want to see in the NHS.

Our public position statement outlined the RCP’s commitment to embedding shared decision making and have developed a range of practical support and resources to help bring about change:

  • our ‘patients as partners’ workshop supports clinicians and teams to reflect on their own practice and identify how local systems and processes may inhibit or enable person-centred care
  • our video resources include case studies and advice on how making small service changes can facilitate shared decision making
  • our collaboration with the MRCP(UK) PACES team – who design the practical exams to test trainee doctors’ communication skills and ethical understanding – means all doctors seeking to go on to specialty training will be tested on their knowledge and ability to do shared decision making.

Making person-centred care the norm

The Five Year Forward View has set out the NHS’s ambition for a new relationship with individual people, their carers, and communities. The RCP wants to see this realised. In this spirit, we recently dedicated an entire issue of the Future Hospital Journal to person centred care, co-designed and developed by people and clinicians, which explores what this new relationship looks like, from shared decision making at individual consultation level through to citizen involvement in service design.

We have a long way to go before person-centred care is the norm. But the extraordinary determination of clinicians like Dr George Perrett at Homerton Hospital and Prof Ben Benjamin in Torbay, and their willingness to challenge existing cultural attitudes and drive changes that promote collaborative approaches to healthcare, show that it is possible. The RCP’s Future Hospital Programme will continue to support clinical leaders, working in partnership with people, carers and communities, to get there.

Ella Jackson, Future Hospital Programme project manager at the Royal College of Physicians

Twitter handle: @ellacjackson

References

  1. http://www.cqc.org.uk/content/adult-inpatient-survey-2015
  2. De Silva D. Helping people share decision making. London: The Health Foundation, July 2012, p.9. www.health.org.uk/publications/helping-people-share-decision-making
  3. O’Connor AM, et al. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Affairs, web exclusive, 7 October 2004.
  4. De Silva D. Helping people share decision making. London: The Health Foundation, July 2012, p.9. www.health.org.uk/publications/helping-people-share-decision-making

 

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