Shared Decision Making Workshop Rachel Bryers

Why are we here?

What average percentage of patients say they wanted to be more involved in decisions about their health care? 1.10% 2.30% 3.50% 4.75% 5.85%

Percentage of patients who wanted more involvement in decisions about their care

What proportion of their patients do doctors believe want more information on their treatment? 1.Only a minority 2.About half 3.The majority

What is Shared Decision Making? A process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. What are they Sharing? Department of Health Website – 14/02/11 Clinician Diagnosis Cause of disease Prognosis Treatment options Outcome probabilities Patient Experience of illness Social circumstances Attitude to risk Values Preferences

Jim – Scenario 1 You are a patient who has been admitted to an Intermediate Care Unit. The MDT has concerns about your ability to manage at home. You have a history of several strokes and two heart attacks. Despite your physical disabilities you have stated you wish to return home but the District Nurses are concerned about you and your wife’s ability to cope, even with a package of care from Social Services. Your mobility has deteriorated and you are now struggling to manage the stairs. The District Nurses feel the time has come for you to consider a move into a nursing home as they feel you need 24 hour care. How would you feel in this situation? How would you respond? What would you expect from the health professionals involved in your care?

Jims Story

Why is SDM Needed? Respecting patient autonomy Improving patient experience ‘No decision about me, without me’ –Giving patients choice and confidence in their treatment options and decisions. –Health and Social Care Act (2012). –Mental Capacity Act –Montgomery Case

Penny – Scenario 2 You are a 66 year old woman who has a consultation with your GP describing hip pain due to arthritis. You are now finding the pain increasingly difficult to live with as your mobility has deteriorated and you are unable to sleep. You are also the main carer for your father who has dementia. He is now living with you after your husband died last year. Your children have suggested that you consider moving your father into a nursing home but you feel you should care for him. You have a consultation with your GP and ask for advice about the hip pain. You explain that your hips have been bad for years but now the pain is terrible. How would you expect the GP to respond?

Penny's Story

Challenges for patients How can you promote Shared Decision Making? What challenges do you think you might face?

Challenges from clinicians “Patient’s don’t want to be involved “ “We do it already” “It takes too long”

Tools/Resources

It takes too long? Jeans Story

Shared Decision Making …a process in which patients are encouraged to participate in selecting appropriate treatments or management options when they are faced with a preference sensitive decision.