Engaged and informed patients: The potential of shared decision making ……… a King’s Fund Conference October 2010

Better, sooner, more convenient 2 The problem People want more involvement in decisions about their health care A priority for 10 years, but little evidence of progress In a “cold” financial environment there’s greater focus on  unwarranted variation  and the possibility that the NHS is “over-producing” ………shared decision may assist with these challenges

Better, sooner, more convenient 3 A definition “Supporting individuals so that they may make rational health and medical decisions based on a consideration of benefits and risks (for them)………….and their values and preferences.” Dr Steven Laitner National Clinical Lead …..but the concept is many centuries old

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8 Decision aids reduce rates of discretionary surgery

Better, sooner, more convenient 9 Decision aid + coaching in gynaecology

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Better, sooner, more convenient 13 The collaboration between doctors and patients can be improved

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Better, sooner, more convenient 15 Patient criteria for web-based interventions A single, trustworthy site – few external links Easy navigation Attractive presentation; tone & voice important Information  Detailed, specific, practical, regularly updated  User controls access to information Range of interactive facilities including  Chat rooms/forums  Q & A  Formal behaviour change and decision support

Better, sooner, more convenient 16 Data from systematic reviews They can “work” ie they can improve users’ Knowledge Self-efficacy Intentions Perceived social support Mood Health behaviours Clinical outcomes

Better, sooner, more convenient 17 But there’s still a lot we don’t know How they work Who they work for What health problems do they help with How to encourage people to use them How to integrate them into routine NHS care

Better, sooner, more convenient 18 Patient decision aids already commissioned

Better, sooner, more convenient 19 Integrated tools and approaches

Better, sooner, more convenient 20 Some “quotes”

Better, sooner, more convenient 21 Some key themes Outpatients is an 18 th century model of healthcare delivery Our health system is too “hospital centric” – there’s a need to Destabilise hospitals Get hospital consultants reconnected with their communities Issues of health literacy apply to patients and clinicians - particularly statistical information There’s a need for a customised approach that’s appropriate for different sub- populations The value of patient to patient experiences (and stories) And Don’t put decision tools out their passively – it’s the support and processes that surround the web resource that makes the difference Identify the “decision window”

Better, sooner, more convenient 22 Three simple components Self care Guidelines – these should be for patients The veto rule – help people to say no “The NHS needs new entrants to trigger disruptive change” The focus should be on shared decision making as a clinical activity, not on decision aids………clinicians need support to change People with long term conditions are the ultimate decision makers and risk takers ………should they be called punters rather than patients?