embedding shared decision making in routine care
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Online Learning Series Right Care for Populations. Embedding Shared Decision Making in Routine Care. Dr Steven Laitner @ SteveLaitner. What is Shared Decision Making. Shared decision-making is a process which involves Patients :. as active partners with their clinician; - PowerPoint PPT PresentationTRANSCRIPT
©2011 the Strategic Projects Team Part of the Strategy & Policy Directorate
Embedding Shared Decision Making in Routine Care
Dr Steven Laitner@SteveLaitner
Online Learning Series Right Care for Populations
©2012 Copyright notice Reference 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:
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What are they sharing?
Clinicians
DiagnosisCause of disease PrognosisTreatment optionsOutcome probabilities
Patients
Experience of illness
Social circumstances
Attitude to riskValuesPreferences
• Diagnosis• Cause of disease • Prognosis• Treatment options• Outcome probabilities
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%
Wanted more involvement in treatment decisions:
Source: NHS inpatient surveys
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Choice of Modality
• 38%
20%
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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”
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2x
10x
Importance of patient preferences
Consensus about evidence / necessity
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Variation in UK
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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.
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Decision Aids reduce rates of discretionary surgery
RR=0.76 (0.6, 0.9)
O’Connor et al., Cochrane Library, 2009
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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.
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The National SDM Programme
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Established Kidney Disease (x 3)Cataracts
AAA Repair Pregnancy after c-section Depression
AAA Screening Menorrhagia Blood pressureOsteoarthritis Hip Rheumatoid Arthritis COPDOsteoarthritis of the knee Carpal tunnel syndrome Atrial Fibrillation
BPH (LUTS) Stable angina SciaticaPSA Testing Serous Otitis Media Inguinal HerniaLocalised Prostate Cancer Recurrent Tonsillitis Acne
Localised Bladder cancer Type 2 NIDDM (x 2) Cholecystitis
Localised Lung cancer Smoking cessation Obesity
Localised Breast Cancer Cholesterol Amnio/CVS
Totally
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“Give people the care they need and no less; the care they want and no more”
Al Mulley
Twitter: @SteveLaitner
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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/
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Online Learning Series Right Care for Populations
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