1. ©2011 the Strategic Projects TeamPart of the Strategy & Policy Directorate Embedding Shared Decision Making in Routine Care Dr Steven Laitner @SteveLaitner Online Learning Series Right Care for Populations

2. ©2012 Copyright noticeReference or date What is Shared Decision Making as active partners with their clinician; in clarifying acceptable medical options; and in choosing a preferred course of clinical care. Shared decision-making is a process which involves Patients:

3. ©2012 Copyright noticeReference or date What are they sharing? Clinicians Diagnosis Cause of disease Prognosis Treatment options Outcome probabilities Patients Experience of illness Social circumstances Attitude to risk Values Preferences Diagnosis Cause of disease Prognosis Treatment options Outcome probabilities

4. ©2012 Copyright noticeReference or date % Wanted more involvement in treatment decisions: Source: NHS inpatient surveys

5. ©2012 Copyright noticeReference or date Choice of Modality 38% 20%

6. 6 Some quotes from our Service User Reference Group “ recognise the “patient” as an expert in themselves” “listen to us” “don’t only concentrate on the clinical” “be aware that management of the LTC is only a small part of my life” “I want to be seen as a whole person” (ortho example) “stop using language and knowledge as a barrier” “speak to me with respect”

7. ©2012 Copyright noticeReference or date 2x 10x Importance of patient preferences Consensus about evidence / necessity

8. ©2012 Copyright noticeReference or date Variation in UK

9. ©2012 Copyright noticeReference or date Risk Groups and Survival Low Risk (33.5%) Medium Risk (56.7%) High Risk (8.9%) Chandna SM et al. Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity. BMJ 1999; 318 : 217- 223.

10. ©2012 Copyright noticeReference or date Decision Aids reduce rates of discretionary surgery RR=0.76 (0.6, 0.9) O’Connor et al., Cochrane Library, 2009

11. ©2012 Copyright noticeReference or date Why shared decision making? The benefits are: Improving patient satisfaction, experience, knowledge; Helping patients make healthcare choices aligned with their personal needs, values and circumstances; Improving clinical outcomes and safety; Achieving the right intervention rate and reducing unwarranted practice variation; Reducing cost and litigation costs.

12. ©2012 Copyright noticeReference or date The National SDM Programme

13. ©2012 Copyright noticeReference or date Established Kidney Disease (x 3) Cataracts AAA RepairPregnancy after c-sectionDepression AAA ScreeningMenorrhagiaBlood pressure Osteoarthritis HipRheumatoid ArthritisCOPD Osteoarthritis of the knee Carpal tunnel syndromeAtrial Fibrillation BPH (LUTS)Stable anginaSciatica PSA TestingSerous Otitis MediaInguinal Hernia Localised Prostate Cancer Recurrent TonsillitisAcne Localised Bladder cancerType 2 NIDDM (x 2)Cholecystitis Localised Lung cancerSmoking cessationObesity Localised Breast CancerCholesterolAmnio/CVS Totally

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17. ©2012 Copyright noticeReference or date “Give people the care they need and no less; the care they want and no more” Al Mulley steven.laitner@nhs.net Twitter: @SteveLaitner

18. ©2012 Copyright noticeReference or date Since March 2013, the national shared Decision Making Programme is being run by the NHS England Patients and Information Directorate. You can find out more about the SDM programme at the NHs Networks site here: http://www.networks.nhs.uk/nhs-networks/shared-decision- making-sdm The Patient Decision Aids can be found here: http://sdm.rightcare.nhs.uk/

19. 19 Online Learning Series Right Care for Populations Follow Right Care online Subscribe to get a weekly digest of our blog alerts in your inbox, Receive occasional eBulletins Follow us on Twitter @qipprightcare Find the full series at: www.rightcare.nhs.uk/resourcecentre