Shared Decision Making - e-Learning for Healthcare
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This programme is in partnership with...
  • Advancing Quality Alliance
  • academy of medical royal colleges

About the Shared Decision Making programme

This e-learning resource provides guidance on what Shared Decision Making (SDM) is and how to implement it in practice. It also provides resources to help health professionals learn the required skills. The e-learning sessions include films to illustrate examples of good and bad consultations and prompts, along with resources to aid health professionals with their work.

Why use Shared Decision Making?

Increasingly, patients want to be involved in making decisions about their own healthcare, and research has shown that, when they do so, they select less hospital care and report better hospital experiences. Some of the benefits of Shared Decision Making are:

  • Increased patient involvement and engagement
  • Improved communication
  • Reduction in complaints and litigation
  • Ethical demand management
  • Enhanced recovery
  • Unwarranted variation

Making a good decision

SDM is not just about ensuring the patient is involved with the process, it is also about making sure the decision reached is a good decision. A good decision is one that is approached systematically, is based on reliable, evidence-based information, and with time allowed to consider all the options carefully. The examples chosen are used to help get people to think about making good decisions.

Who is this tool for?

The Shared Decision Making e-learning package is suitable for all healthcare professionals, health improvement personnel and patient engagement representatives to inform and educate them on Shared Decision Making in order to embed it in day to day clinical practice. Shared Decision Making represents a cultural change in behaviour and this tool will aid and assist in changing  an environment of medical paternalism to a more inclusive approach based on the 2012 Health Act ‘Liberating the NHS: ‘No decision about me without me’.

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Patient participation in decision making

Not being properly told about their illness and the options for treatment is the most common cause of patient dissatisfaction. Most patients want more information and a greater say in decisions about how they will be treated. Shared Decision Making (SDM) is a process in which patients are encouraged to participate in selecting appropriate treatments or management options.

In Shared Decision Making, patients are involved as active partners with their health professional in clarifying acceptable medical options and choosing a preferred course of clinical care. Shared Decision Making is appropriate in any situation when there is more than one reasonable course of action and no one option is self-evidently best for everyone. This situation is very common since there are often many ‘preference-sensitive’ decisions. In these cases, the patient’s attitude to the likely benefits and risks should be a key factor in the decision.

Sources of expertise

SDM relies on two sources of expertise:

  • The health professional is an expert on the effectiveness, probable benefits and potential harms of treatment options
  • The patient is an expert on herself, her social circumstances, attitudes to illness and risk, values and preferences

Both parties must be willing to share information and accept responsibility for joint decision-making. The clinician must provide patients with information about the diagnosis and treatment options and the patient must tell the clinician about their preferences.

Course - Guidance on Shared Decision Making

‘Guidance on Shared Decision Making is a course developed by Health Education England (HEE) e-Learning for Healthcare (HEE e-LfH) and the Advancing Quality Alliance (AQuA).

The course consists of two e-learning sessions and provides an overview of person-centred care focusing on shared decision making, self-management support and motivational interviewing. It discusses the need for a change in current practice and provides healthcare professionals with information on the drivers for person-centred care, the legal framework which supports it and the tools and resources to embed it within clinical practice.

Access the course here: https://portal.e-lfh.org.uk/Component/Details/391546

Course - Dialogues in Shared Decision Making

Dialogues in Shared Decision Making is a course for GPs created by HEE West Midlands in partnership with GPs, GP trainers and trainees, patients and others.

The aim of the course is to enable both trainee and established GPs to improve their skills in involving patients in decisions made about their care. For shared decision-making to work, GPs need good consulting skills, which is what this course is about. This course focuses on consultations between a patient and a GP on 12 different concerns, such as missed periods, a tingling arm, headaches and an unexpected pregnancy. The consultations, which are based on real patient encounters, are films showing both good encounters and ones in which the GP does not succeed in sharing the decision-making with the patient. There is then a further film in which the patient says how they found the consultation and a document which raises some of the arising issues.

Access the course here: https://portal.e-lfh.org.uk/Component/Details/429361

Course - Talking about What Matters

Talking About What Matters is a course developed by HEE West Midlands intended to explore in greater depth the interactions between doctors and patients that help create a meaningful outcome to consultations.

The course consists of a series of patient scenarios and is designed to be applicable across primary care and not confined to medical professionals.

Access the course here: https://portal.e-lfh.org.uk/Component/Details/429363

Course - Communicating Risk - Primary Care and Perioperative Medicine

The Communicating Risk course was originally commissioned by the Australian Commission on Safety and Quality in Health Care and has been licensed to the Academy of Medical Royal Colleges (AoMRC) as part of Choosing Wisely UK. It has been adapted for the UK by the Winton Centre for Risk and Evidence Communication at the University of Cambridge.

There are two versions of this course – the first is aimed at primary care professionals and the second is aimed at perioperative medicine professionals. Each course is designed to help clinicians develop skills for communicating effectively with patients about the risks and benefits of treatment options. Each course consists of four sessions and will take approximately two hours to complete, with each session taking approximately 30 minutes to complete.

Health decisions often have no single ‘best choice’ and require choosing from multiple options, each with potential benefits, harms, trade-offs and uncertainties. For patients (and carers) to understand and have the opportunity to be actively involved in sharing decisions, clinicians need to provide relevant and clear information about the options, and the potential benefits and harms of each. This information should reflect the best available evidence and also take into account the patient’s personal opinions, preferences, values and priorities. This often requires analysis and being able to convey quite complex numerical information. Yet few clinicians have any training in how to do this.

Each version of the course includes examples taken either from primary care or perioperative medicine, and is suitable for any healthcare professional. It includes self-test questions and video consultation case-studies. By the end of each course, participants will be able to:

  • describe why it is important for clinicians to effectively communicate benefits, harms, trade-offs and uncertainties with patients
  • explain the inter-relationship between shared decision making, evidence-based medicine and patient-centred care in the context of communicating benefits and
  • list key communication skills needed when talking with patients about evidence
  • explain how to effectively communicate statistical information to patients
  • outline the role of decision support tools, potential uses and where to locate them

Authors

  • Professor Tammy Hoffmann, PhD Professor of Clinical Epidemiology, Centre for Research in Evidence-Based Practice, Bond University, Australia
  • Professor Chris Del Mar, MD, FRACGP, FAFPHM Professor of Public Health and General Practitioner, Centre for Research in Evidence-Based Practice, Bond University, Australia
  • Dr Raquel Newman, BVSc, MANZCVSc (Emergency and critical care), EMA. Medical Writer.
  • Dr Ramai Santhirapala FRCA FFICM FHEA, Clinical Lead, Choosing Wisely UK, Academy of Medical Royal Colleges
  • Dr Alexandra Freeman, Executive Director, Winton Centre for Risk and Evidence Communication

The authors were also assisted by a steering committee in risk communication and other contributors and reviewers from a range of clinical specialties.

Access the Primary Care course here: https://portal.e-lfh.org.uk/Component/Details/543267

Access the Perioperative Medicine course here: https://portal.e-lfh.org.uk/Component/Details/529401

How to access

In order to access any e-LfH programme, you will need an e-LfH account. If you do not have one, then you can register by selecting the Register button below.

Register >

If you already have an account with e-LfH, then you can enrol on to the Shared Decision Making programme by logging in to the e-LfH Hub, selecting My Account > Enrolment and selecting the programme. You can then access the programme immediately in the My e-Learning section.

Access for NHS healthcare staff in England

The Shared Decision Making programme is also available to NHS healthcare staff via the Electronic Staff Record (ESR). Accessing this e-Learning via ESR means that your completions will transfer with you throughout your NHS career.

Further details are available here.

e-LfH is a Health Education England Programme in partnership with the NHS and Professional Bodies