Shared decision-making

Under the NHS Constitution:

“You have the right to be involved in planning and making decisions about your health and care with your care provider or providers, including your end of life care, and to be given information and support to enable you to do this. Where appropriate, this right includes your family and carers. This includes being given the chance to manage your own care and treatment, if appropriate.”

NHS CONSTITUTION

What is Shared Decision Making? 

The Government wants to achieve healthcare outcomes that are amongst the best in the world.  They want patients fully involved in their own care – no decision about me, without me.  They want decisions made in partnership with clinicians rather than by clinicians alone.

Shared decision making is an approach where clinicians and patients communicate together using the best available evidence to make decisions on treatments, management options and support options of an illness.

NHS England explains shared decision-making on their website as follows:

“Shared Decision Making is a process in which patients, when they reach a decision crossroads in their health care, can review all the treatment options available to them and participate actively with their healthcare professional in making that decision.”

“To achieve this, we are encouraging the development of new relationships between patients, carers and clinicians, where they work together, in equal partnership, to make decisions and agree a care plan. In addition, we want to put shared decision making not only at the care level, but also at the strategic and commissioning level, with patients involved in the co-design, co-commissioning and co-production of healthcare.”

The National Institute for Health and Care Excellence (NICE) states on their website:

“Shared decision making puts people at the centre of decisions about their own treatment and care, by:

• exploring care or treatment options and their risks and benefits
• discussing choices available
• reaching a decision about care or treatment, together with their health and  social care professional.”

Read more about what NICE say about shared decision-making.

Research on this topic has shown that although the clinician has knowledge in respect of the diagnosis, disease causes, outcome of the disease and treatment options, it is the patient who has the actual experience of the illness and their social circumstances, attitude to risk, their values and preferences should play an important part in making a decision in regard to their health.

It has been shown that if the clinician and patient share information in respect of all these things, then the outcome for the patient is better.

There are many things that patients want to know when they visit a doctor such as:

• What’s the cause of my symptoms?
• Is there more than one way to treat my condition?
• Will treatment relieve the symptoms?
• What are the risks?

Decision aids have been designed for some conditions to help the patient answer these questions.  The decision aids provide facts about the condition, the options for treatment, the expected outcomes and probabilities.  They help patients clarify and communicate their thoughts about the outcomes that matter most to them, not those that matter most to the doctors.

There is much evidence showing that decision aids have led to:

• greater knowledge for the patient
• more accurate risk perceptions
• greater comfort with decisions
• greater participation in decision making
• fewer people undecided about their options
• fewer patients choosing major surgery

Most people have to make healthcare decisions at some time in their lives and people want clinicians to listen to them, explain and answer their questions. Many want more information than is given to them by their clinician and most, but not all, people want to be involved in treatment decisions. As we know, people with long-term conditions have to self-manage and making health decisions is part of that.

Read NICE information about making decisions about your care or see a list of decision aids

At present, there are no decision aids for thyroid disease.

When you visit your healthcare practitioner, remind him or her of the ethos of shared decision-making when you are discussing your thyroid health.

Date updated: 09/05/21 (V1.1)
Review date: 19/05/22