COMMENT
change. The NHS Commissioning Board, NICE and local commissioners should en- sure that commissioning standards and contracts identify decision points in care pathways and monitor the quality of deci- sion-making by using appropriate patient- reported metrics.
There are at least three challenges that will have to be faced if the Government’s aspi- ration is to become a reality. These involve improving the provision of information and support for patients, ensuring that all clini- cal staff embrace the relevant attitudes and competencies for shared decision-making and incentivising change through effective commissioning.
Decision aids
The process of developing and distributing patient decision aids has already begun, with both NHS Direct and NHS Choices making a number of web-based tools avail- able covering some of the most common conditions. Also ‘hard copy’ decision aids for prostate cancer and benign prostatic hypertrophy, using DVDs and booklets, have been made available to urology de- partments across the country, winning a
BMA award. However, ensuring that peo- ple know about these and persuading clini- cians to make them available to their pa- tients has proved diffi cult to date. A much more effective marketing strategy will be required, preferably led by clinical organi- sations such as the medical and nursing Royal Colleges.
Decision support
Studies reveal that doctors, nurses and other clinicians often think they are shar- ing decisions more than their patients do. While almost everyone agrees that patients should be asked to give their consent be- fore receiving invasive treatment, this does not mean they are always given full infor- mation about the alternatives and encour- aged to express their preferences and to make a truly informed decision. Similarly, many clinicians see themselves as solely re- sponsible for planning care for people with long-term conditions, oblivious of the fact that the plans would be much more effec- tive if developed collaboratively.
What does effective decision support look like?
Two pilot projects run by the Health Foun- dation, entitled Co-Creating Health and MAGIC, are testing new ways of encour- aging staff to learn and practice the new skills and these should provide valuable experience on which to base future training courses. The programmes are also testing patient reported measures of clinical be- haviours in the consulting room – the aim being that these measures can be used not just to stimulate change in frontline staff, but to benchmark healthcare providers of the future. We envisage that future com- missioners will use these metrics to pur-
24 | national health executive Sep/Oct 11
chase services that employ the principles of shared decision making and patients will use the metrics to ensure that they choose to work with services that provide effective decision support.
Conclusion
Working in partnership with patients to plan their care can generate valuable infor- mation to inform the commissioning pro- cess and priorities for future investment. When patients and clinicians work togeth- er to plan care through shared decision- making, they soon identify which services are needed and which aren’t, and where the gaps are.
Embedding shared decision-making into systems, processes and workforce atti- tudes, skills and behaviours is a challenge. It will require a combination of effective clinical leadership, social marketing, in- centives, practical support, education and training, measurement and feedback, and patient push. The Government’s White Pa- per set the direction of travel, but people working at the front line of services need more help if services are really to become more personalised in future.
Angela Coulter
Alf Collins
FOR MORE INFORMATION Download ‘Making Shared Decision- making a Reality’ at:
www.kingsfund.org. uk/decisionmaking
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