Shared Decision Making: A Cornerstone of Personalised Care
Shared Decision Making (SDM) marks a pivotal shift from traditional paternalistic healthcare models to a collaborative, person-centred approach. This framework acknowledges that healthcare decisions should reflect not only clinical evidence but also the unique preferences, values, and circumstances of each individual. By fostering a partnership, SDM positions patients as experts in their own lives while clinicians contribute their medical expertise. This synergy ensures that care is truly tailored to the individual.
What Good Shared Decision Making Looks Like
1. Involvement in Decisions
SDM ensures individuals are involved in their care decisions to the extent they desire, empowering them to actively select the best course of action when their health status changes.
2. Understanding Options
The SDM process helps individuals:
- Understand their diagnosis.
- Explore available options, including the choice to take no action.
- Evaluate the risks, benefits, and consequences of each option using evidence.
By considering personal attitudes toward risk, trade-offs, and preferred outcomes, individuals can make informed decisions collaboratively with their healthcare team.
3. Evidence-Based Tools
SDM is enhanced by decision-support tools that:
- Aid understanding, particularly for those with low health literacy.
- Clearly outline the benefits, harms, and consequences of options.
These tools provide the information individuals need to make confident, informed decisions.
4. Preparing for the Conversation
Effective SDM involves preparation, including:
- Access to Information: Providing resources before, during, and after appointments.
- Encouraging Engagement: Promoting models like “Ask 3 Questions” or the BRAN approach (Benefits, Risks, Alternatives, Nothing).
Communicating Risk Effectively
Clear risk communication is crucial for informed decision-making. Misinterpretation of risks can lead to poor outcomes or unnecessary anxiety. Best practices include:
- Using absolute risks (e.g., “1 in 100”) over percentages.
- Employing visual aids like charts or graphs.
- Contextualising risks with relatable comparisons.
Clear communication fosters trust and enables decisions based on a realistic understanding of potential outcomes.
The Role of Patient Decision Aids
Decision aids simplify complex healthcare choices by providing evidence-based information in accessible formats. Examples include:
- Online calculators for cardiovascular risk.
- Booklets or videos explaining cancer screening.
- Interactive apps for shared decision-making during consultations.
These tools enhance autonomy and improve decision quality.
The BRAN Framework for Exploring Options
The BRAN framework (Benefits, Risks, Alternatives, Nothing) offers a structured approach to presenting choices during consultations. This involves:
- Explaining the benefits of each option.
- Outlining potential downsides.
- Offering alternative paths.
- Discussing the implications of taking no action.
This comprehensive method supports informed and confident decision-making.
Reflection and Skill Development in SDM
Mastering SDM requires continuous practice and feedback. Clinicians can improve through:
- Role-playing challenging scenarios.
- Incorporating patient feedback.
- Engaging in interdisciplinary discussions.
By refining their communication skills, healthcare professionals can foster more meaningful interactions.
Building Trust Through Communication
Trust is fundamental to SDM. Clinicians must approach every interaction with empathy, transparency, and respect. Key elements include:
- Active listening without interruption.
- Validating patients’ feelings and concerns.
- Providing clear, jargon-free explanations.
Building trust encourages patient engagement and leads to better outcomes.
Integrating SDM into Personalised Care
SDM bridges the gap between clinical expertise and individual preferences, transforming the clinician-patient relationship into a genuine partnership. While SDM is a present-oriented conversation focused on immediate decisions, Personalised Care and Support Planning (PCSP) is proactive, addressing the long-term needs of individuals with chronic conditions. Both approaches enable informed choices rooted in what matters most to the individual.
Understanding a person’s knowledge, skills, and confidence (referred to as their “activation”) enhances SDM conversations. By engaging with these factors, healthcare professionals can foster more meaningful and productive dialogues.
Social Prescribing complements SDM by connecting individuals to community resources for emotional and practical support. It can serve as a standalone option or complement medical treatments, reinforcing the holistic, personalised care model.
Benefits of Shared Decision Making
- Personalised Care: Aligning decisions with individual preferences reduces decision regret and fosters confidence.
- Improved Outcomes: Informed decisions based on understanding enhance adherence to treatment plans and health outcomes.
- Efficient Resource Allocation: On a population level, informed decision-making supports better service delivery and resource management.
By embracing SDM, healthcare professionals uphold their ethical responsibilities, delivering care that is not only evidence-based but deeply personal. This collaborative approach improves health outcomes, patient satisfaction, and the overall quality of care.