Shared decision making in health is a concept which, over the last 20 years, has been a focus of extensive research. Medical Colleges worldwide promote this style of consulting to their practitioners. Shared decision making means the sharing of information between the practitioner, about possible treatment options and pathways, and the patient, of their preferences and experience, to arrive at a decision which seems most appropriate in that setting and at that time (1). 

It is usually applied when there are multiple options which would lead to similar outcomes (2). An example of this is contraception. Several choices are often available to each person considering contraception. The best choice for each person may however be different, depending upon medical history, side effects and personal preference. Deciding what to try could follow a shared decision-making process. 

You may ask yourself why would we do this, surely the doctor should know what would be best for me? 

A doctor may be highly trained in the clinical evidence and viable management options based upon individual circumstances. However, where multiple management options exist, the patient’s expertise in their own life, background and preferences should be factored into the decision-making process. Evidence shows this improves patient satisfaction with outcomes (3). 

Why then, don't we always do this? 

In 2009, through my work at Cardiff University, with Professors Elwyn and Edwards, I became one of two clinical leads for primary care in the Health Foundation SDM implementation study MAGIC phase 1(4). This work taught us that, in order to practice shared decision-making, a clinician needs to want to do it, have the skills to do it and specific shared decision-making tools can assist this process (5). 

Integriti clinics seek to provide the clinician will, skills and tools to promote SDM in routine clinical encounters.  

Please try our preference led support tools or book an appointment to benefit from this style of consultation.

References

• Elwyn G, Laitner S, Coulter A, et al. Implementing shared decision making in the NHS. BMJ 2010;341:c5146 
• Elwyn G, Frosch D, Kobrin s. Implementing shared decision-making: consider all the consequences. Implementation Science 2016; 11:114 
• Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Mak. 2015; 35:114-31 
• https://www.health.org.uk/funding-and-partnerships/programme/magic-shared-decision-making accessed 23/10/2019 
• Joseph-Williams NJ, Lloyd A, et al. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ 2017;357: j1744