Shared Decision Making
Skills workshop –v4.2 22.5.2013
Clinicians, patients, and policy makers must find the
competence, curiosity, and courage to … improve the
quality of medical decision making (Al Mulley 2010, BMJ).
Shared decision making is an approach where clinicians
and patients make decisions together using the best
available evidence. (Elwyn et al BMJ 2010.)
“No decision about me, without me”
Author: Dave Tomson
Document Version V4.2
Date: 24.5.2013
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content
1.
Aims and Objectives
…………………………………………….3
1.1 Outline of the workshop………………………………………………...3
1.2 The Workshop.. …………………………………………………………….4
2.
Exercise – Exploring attitudes ………………..….........................7-10
2.1 MAGIC and SDM – What do you know already?.........................11
2.2 Introducing MAGIC and Shared Decision Making……………….11
3.
Core Skills in Shared Decision Making……………………………..13
3.1 Key Assumptions in Shared Decision Making
3.2 Three key stages in Shared Decision Making
3.3 Core skills used in Shared Decision Making………………………14
3.4 Choice Talk……………………………………………………………...14
3.5 Option Talk………………………………………………………………16
3.6 Preference/Decision Talk..……………………………………………17
3.7 Practice…………………………………………………………………..19
4.
Wrapping up and next steps…...…………………………………….21
5.
List if key papers and websites………………………………………23
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1. Aims and objectives
These are the aims and objectives we have set for this session.
YOU will have:
 Gained a clear overview of the nature of Shared Decision Making (SDM),
 Explored your attitudes to SDM and some of the reasons why doing it even
better might be important
 Understood and practiced a number of core skills in SDM:
o Introducing choice, inviting participation and exploring options
o balancing good quality information of the risks benefits and
consequences of these options
o Using decision support materials
o Exploring what matters to the patient
o Arriving at a shared decision that is ‘right’ for the patient
 Have a better idea of your next steps in embedding SDM in your own practice
and, where appropriate, in your organisation.
1.1 Outline of the workshop.
First Section
Introductions and getting prepared
Aims of the workshop and housekeeping
Exploring attitudes – what makes for a good decision?
Why bother with SDM?
What do you want out of this session (learning needs)?
Second section
Introducing and exploring the model of Shared Decision making
Third section
Rehearsing the skills
Using patient decision support materials
Break
Fourth section
Further rehearsal of the skills without dedicated decision support
Final section
Wrapping up and consolidating
Next steps for your team
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Engagement and getting prepared:
Variation one
This exercise helps you reflect on what you are doing today and how you are
actually feeling right now
Spend no more than 5 minutes drawing a representation of how you are feeling right
now, making some reference to your feelings about the training session that is
coming up
We will briefly share out pictures in the group
notes
Variation two
Please score the following statements between 1 and 10 where 10 is completely
agree and 1 is completely disagree.
Statement
I am looking forward to today and feel it is likely to improve my consulting skills
Statement
I think shared decision making is an important part of what a clinician should do
Statement
I was not at all keen to come today
Notes – what does this tell me about myself?
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Setting the scene
1.2 The workshop
This workshop has been designed to maximise the learning opportunities available to
you in three short but very precious hours. We have used evidenced based
educational design – including brief small group exercises, the use of rehearsal with
facilitators or colleagues, self reflective moments and a workbook to help
consolidate learning.
The timings are very clear and tight in order to facilitate maximum exposure to skills
development.
1.3 Use of the workbook
The workbook provides you with a complete guide to the workshop and contains all
the slides and exercises, along with space for you to identify your own learning
needs and ‘take homes’ /action points.
We have also included a number of supplementary sections to help flesh out some
of the thinking, to give examples and to help you over the next few months.
1.4 Brief discussion of microskills and role of feedback
The most effective method for starting to learn a new clinical skill is to see it done
and then practice doing it yourself with feedback on your performance.
Psychologists tell us that you then have to practice new skills for >40 days before
they begin to become ‘embedded’ in the core automatic skill set of an individual
learner. So today is just the start!
Brief sessions, during which you will practice part of the SDM skill set, are a key
component of the workshop. Some of you will be comfortable with this way of
learning, others may be less so. Please just give it a go. Facilitators are there to help
and we encourage all participants to be supportive – after all you will all be in the
‘hot seat’ at times. The great advantage of microskills practice is that you can stop
the exercise at any stage and start again or try something different. We strongly
encourage you to do this – it is not a chance for you to demonstrate your brilliance
to others – it is a chance to learn how to do things differently!
1.5 Clinical scenarios
Some of you may not be familiar with the clinical scenarios we will use today - we
are aware that this makes it harder in some ways – BUT please do not get hung up
too much on content – you are practicing a process – it is learning to say –“you have
choices” and “ can I run through the options briefly then we can look at the pros
and cons in detail” and “when looking at the pros and cons – what seems to matter
most to you?”. – What the detail of the options are and whether you are familiar with
this matters much less! (for today at least)
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1.6 Feedback
The most effective feedback is descriptive. Telling someone you liked this bit or did
not like that bit is not nearly as helpful as sentences that begin “when I saw you do
or say X, then I noticed Y really took note/ understood what you were saying/ was
turned off and irritated…”
Try and start by separating the person from the behaviour. Comment on the
behaviour. It can be helpful if you also have something to offer in the way of a
different way of saying or trying that skill or part of the consultation.
1.7 One caveat
We are teaching a dynamic and iterative process as though it was a linear set of
skills. Of course this is not the case. There are many variations on MAking a Good
decision In Collaboration: variations of context, subject, order of proceeding, timing
etc. The purpose of today is to make clear to you the possible skills and stages of
SDM in practice and how these might differ from some of the ways you have worked
in the past.
1.8 Responsibilities as learners
You can help maximise the benefits of the workshop by being careful to attend both
to your own learning needs AND helping create a safe and industrious environment
where your colleagues can also learn.
1.9 Evaluation
This is work in progress so all feedback on this workshop will be useful to us.
Please complete the evaluation form at the end of the session
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2. Exercise: Exploring our beliefs and attitudes
Variation ONE
What helps make good decisions? – 5 minutes
In pairs:
Identify an important decision in your life involving a choice between options – this
might be buying a car, house, moving to a different job, choosing a holiday, making
a lifestyle change like weight loss, a treatment decision or something quite different.
Just spend a minute jotting down what you did to get to the decision that was right
for you. What were the key components of this decision making process? And what
was important for you in helping to make the choice?
Share with your colleague, trying to pick out some of the key elements of decision
making
What did you do to get to the
decision? What was the
process?
What were the key elements of decision
making?
We will briefly reflect on the key themes of good decision making and contrast this
with decision making in clinical settings – how do patients experience decision
making?
Reflections
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2. Exercise: Exploring our beliefs and attitudes
Attitudes Variation TWO
Read these two cases:
Case 1
Katherine: early stage breast cancer
Katherine was 67 when she was diagnosed, widowed, living alone in a
rural location and did not drive. Given the equal overall survival rates,
she was offered a choice between lumpectomy with radiotherapy
(breast conservation surgery) or mastectomy. She was surprised by this
choice and became anxious. She listened to the advice she was given
and, although she was given information, felt steered towards having
a lumpectomy, followed by radiotherapy. She recovered well from the
surgery. She became very tired during the radiotherapy, her breast
became tender and much smaller, an effect that she did not
anticipate. Two years later, a recurrence of the breast cancer was
found and she had a mastectomy. At this point, she became aware
that there was a higher (double) rate of recurrence after lumpectomy
and radiotherapy. She felt regret and considered that her preference
two years ago, had she had been given more information and a
chance to talk about what mattered most to her, would have been to
have a mastectomy.
Case 2
Edward: symptoms due to an enlarged prostate
Edward is 75 and had recently been diagnosed as having an enlarged
prostate gland that caused him bothersome urinary symptoms. He was
offered surgery as the most effective treatment and accepted the
recommendation. He enjoyed an active sex life which was important
to him and his wife. Estimates vary, but 80-90 out of every 100 men who
have this procedure develop retrograde ejaculation (limited or no fluid
ejaculated). He was made aware that some men have sexual
problems after surgery but did not feel as if he’d had a chance to
consider the extent of this risk or to consider whether this was a
concern to him personally. Looking back, he feels that if he had been
given more of a chance to discuss his preferences, he would not have
chosen surgery: he would have chosen active surveillance or would
have chosen to take medication and review his options at a later
stage.
What do they tell us about decision making in clinical settings
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2. Exercise: Exploring our beliefs and attitudes
Variation THREE
You will be given a statement on a coloured piece of card.
Please read it and decided the extent to which you agree with it where:
1 = completely disagree with the statement
10 = completely agree with the statement
Statements available to choose from
1. In the end it is my job to advise a patient on the best treatment, and
encourage them to choose this
2. Shared decision making should only happen when the options offered
are equally effective, otherwise I should advise on the best treatment.
3. Ideally it would be better if the patient had a chance to read up on
their condition, and the options for management, before we made a
decision on the best way forward
4. The person with a long term condition is more likely to act upon the
decisions they make themselves, rather than those made for them by a
professional
5. The clinical consultation between a Health Care Professional and a
person with a health problem is a meeting of equals and experts
6. Healthcare professionals are responsible for supporting patients to
make decisions that the patient feels are best for them, even if the
professional disagrees
7. Patients should only be involved in decisions about alternative
treatments when the alternatives are equally effective
8. Doctors shouldn’t offer their opinion on which treatment might be best
for a patient.
Having given your statement a score please line yourself up on a line
between 1 and 10. – The trainer will show you where 10 and where 1 are in
the room!
You will be invited to group together with the other people who hold the
same colour card and to reflect on why you placed yourselves where you
did on the line.
Reflections
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2. Exercise: Exploring our beliefs and attitudes
Variation FOUR
What’s important to the patient?
Take a look at some of the scenarios below and consider the main issues that
have caused these patients to ask for help from the Patient Advice and Liaison
Service (PALS).
How could have been made better for the patient?
How can shared decision making help?
Mr C has recently had a hip replacement operation. He isn’t happy with one of the
outcomes. He says that although he had asked about different types of replacement
hip he hadn’t been given very much information about pros and cons and wasn’t told
which type it would be until the day of the operation.
Mrs B has three separate conditions. She recently attended an outpatient clinic with
regard to kidney failure where changes to her medication were made. When she
asked about the impact of that on the other medication she is taking she felt she
didn’t get enough or the right information. She is worried about the changes to her
medication and wonders if there might be side effects.
Miss E visited her GP because she has had a cough and sore chest. The GP
advised her to rest and to drink plenty of fluids. He didn’t give her a prescription.
Miss E asked him why she hadn’t been given antibiotics but she didn’t feel she got a
satisfactory answer. Miss E had read the posters in the waiting room explaining that
the GP may not always prescribe antibiotics but she has always had them in the past
and thinks that it is just to save money.
Mr F had his medication changed and now has to be monitored in the hospital clinic.
He had previously been monitored at his GP practice and doesn’t understand why
this has changed. He feels that he is being asked to attend monitoring more
frequently which is inconvenient and worrying. He felt that his GP understood his
circumstances but doesn’t think the hospital clinic understands. He sees different
people on each occasion and doesn’t feel able to ask questions.
Clinical staff thought that Mrs E may not wish to share information with family
members. On realising this, she confirmed that on the contrary she does want her
family to be involved as she doesn’t feel able to make decisions about her health
problems on her own and relies on them to ask the questions and understand what
is being said.
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2.2 Introducing MAGIC and shared decision making (SDM)
Overall nature of the MAGIC project:
 Making Good decisions In Collaboration.
 Making Shared decision making the norm in routine care.
 It is a multi-centre, large scale implementation study over 3 years.
 Looking at how can we embed SDM into mainstream health services.
Core components of MAGIC – and of most effective Change programmes
Leadership
Skills development
Marketing
Patient involvement and activation
Quality improvement methodologies
The nature of shared decision making (SDM)
Shared decision making occupies the middle ground between more traditional
paternalistic or clinician-centred practice, where patients rely on their doctor to
make decisions about their care, and informed patient choice or consumerism,
where patients are given information and then left to make their own choices.
Shared decision making recognises and brings together two important sources of
expertise – the clinical knowledge, skills and experience of the healthcare
professional and the patient’s own knowledge and experience of their condition, its
impact on their life and what is most important to them.
Both forms of expertise are key to making good decisions – ones that are informed,
supported by best available evidence, and compatible with the patient’s personal
preferences, values and circumstances.
The process of shared decision making involves clinicians and patients working
together to consider evidence-based clinical information about tests and treatment
options, likely benefits and outcomes, and potential risks. It enables them to choose,
in collaboration, the course of treatment, management or support that best fits the
patient’s informed preferences.
There is evidence:
 48 % inpatients & 30 % outpatients want more involvement in decisions about
their care (CQC Patient surveys).
 Cochrane Review of decision support (O’Connor, 2009):
 Improves knowledge and more accurate risk perception.
 Increases participation and comfort with decision.
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 Fewer undecided.
 Reduces uptake of elective surgery.
 Improves adherence to medication (Joosten, 2008).
Rewards for clinicians
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Better consultations
Clearer risk communication
Improved health literacy
More appropriate decisions
Fewer unwanted treatments
Improved confidence and self-efficacy
Improved health behaviours
Safer care
Greater compliance with ethical standards
Reduced costs
Less litigation
Better health outcomes
Additional considerations
Ethical
 Principle of patient autonomy
 Competence
 Sufficient information
 Freedom from duress
 Importance of incorporating patient values and opinions
 Just distribution of clinical resources
A doctor registered with the GMC must:
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Listen to patients and respond to their concerns and preferences
Give patients the information they want or need in a way they can
understand
Respect patients’ rights to reach decisions with you about their treatment
and care
Good medical practice ( GMC 2006)
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3. Core Skills in Shared Decision Making:
A summary guide for the consultation
3.1 Key assumptions in Shared Decision Making
The key skills required for undertaking shared decision making are based on the
following assumptions:
1. An informed patient is desirable and important to you as a health care
professional.
2. Engaging patients in treatment decisions where there are real options
is a desired goal and health care professionals need to support
individuals to achieve this.
3. A patient who is not informed of the possible consequences of the
options is not able to determine what is important to them.
The skills required for shared decision making ultimately rest on the ability to engage
patients, help patients become informed and thereby feel empowered to make
decisions and decide what is best for them, collaboratively with their clinician if
desired.
3.2 Three key stages in Shared Decision Making
Figure 1 outlines the three key components of shared decision making:
1. Choice talk
2. Option talk
3. Preference/decision talk
These sometimes occur in sequence, but usually the preference talk (what matters
to me talk) is woven throughout the process. We have identified the preference talk
as a distinct component to emphasise the importance of exploring the preferences
of the patient before decision making and after elaboration of the options, if it has
not been done earlier in the conversation.
Each component can be revisited at any time during the decision making process.
The three key components outlined are supported by two key tasks/processes:
1. Deliberation
2. Patient decision support interventions
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Figure 1 A schema for Shared Decision Making
3.3 Core Skills used in Shared Decision Making
Below we outline the core skills required for the three key components: choice,
option, and preference/decision talk. We lay out the core skills required in each
stage, and provide tips and techniques on how each core skill can be achieved.
3.4 Choice Talk
Within the clinical encounter, the choice talk will occur after a diagnosis or
formulation of the problem has been established. When there is more than one
treatment or management option, the health care professional should introduce the
idea of making a choice to the patient.
Core Skill
Summarise &
signpost a
shift in the
conversation
Introduce
the idea of
choice
Techniques/Tips
Suggest there is an agreement on the nature of the problem (working
diagnosis) and you will now shift the focus to look at options for what
to do next.
Justify the
introduction
of choice &
signpost
‘what’s
important to
you’
This is about
working
together as
a ‘TEAM’
It is important to explain why choice is being introduced. A useful
justification for patients is that without knowing what is important to
them, it is difficult to know what option is best for them.
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It is essential to introduce the concept that more than one option
exists to investigate, manage or treat the problem. Patients are
sometimes unaware there is uncertainty in medicine & outcomes are
unpredictable. Choices could include doing nothing – and patients
often find this liberating!
They are sometimes unaware that their own beliefs, values and
preferences will make a difference to the appropriate next step. Skill is
required to ensure the patient doesn’t think you are offering choice
because you are incompetent/uniformed! Emphasise you are a
professional who is well informed and that you want to share that
knowledge and evidence.
You need to be careful also to emphasise that this is a shared decision.
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You are not just going to give them information and ask them to
decide. Another way of thinking about this is that you are emphasizing
that the patient and you are part of the same ‘team’. However it is
important to recognise you are allowed to have, and give, your own
opinion! Indeed you must be prepared to say what you think and
explain WHY.
Check for
reaction to
choice
Defer
closure
For some patients and clinicians, the idea of introducing choice is
novel and may threaten established relationships. It is important to
check if the patient has understood the ‘choice talk’, which acts as a
gateway to describing the options in more detail. Some patients will
indicate their discomfort/concern and it is important to acknowledge
these concerns.
It is likely that many patients will react by indicating that they don’t
want to be involved in the next steps (e.g. “I don’t know, what would
you do?”, “what do you suggest is best?”). It may also appear that the
patient has already decided.
You need to make a decision whether to ‘pull back’ from a decision
and encourage the patient to learn more about their options (this will
be guided by context & knowledge of the patient and their networks).
To accomplish shared decision making it will be necessary to ask the
patient to defer closure of the process at this stage. Ask permission to
defer closure, check that any concerns have been addressed, and
then you can move to ‘option talk’.
A useful phrase: “I do have ideas about what we might do but before I
give you my opinion, I need to know what matters to you, and we
need to make sure we have looked at all the appropriate options”
Notes on phrases that might be useful
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3.5 Option Talk
At this point, it is assumed that the permission to proceed to describe options has
been achieved. Setting the stage is important, as this step requires a high degree of
skill on the part of the practitioner and a high degree of commitment on behalf of
the patient – to engage, listen and participate.
Core Skill
Check
existing
knowledge
Techniques/Tips
Many patients are aware that options exist. Some will already have
done some research on the area. You may have already picked this
up earlier in the consultation.
You are in a discussion, to which both parties bring information. It is
important to recognise this. Suggest using a BDA OR a blank
decision grid to help inform the discussion
Introducing
This can be done by:
the BDA or
 Accessing directly from www.Patient.co.uk and viewing on
other decision
line
support, where
 Printing off and sharing the reading of it together
appropriate
 Printing off and asking the patient to read it first themselves
Check that the patient is happy to use the BDA, and be aware of,
and sensitive to issues around literacy.
Make it clear that you propose going through the BDA with the
patient, and that it may be possible to arrive at a decision today or,
it may be more helpful for the patient to take the BDA away and
come to a decision after they have had a chance to look at it in
more detail.
List options
Use the ‘check for existing knowledge’ as your starting point.
Start with the summary list of the options available before exploring
each options in more detail.
Exploring the options together. Starting from wherever the patient wants to. If the
patient is unaware of any of the options it will be necessary to go through each
option in turn. In other situations, the patient may be interested in particular options
and it works well to start with these. AND it will be important to check that they are
aware of other options, and that options ‘fit’ with their values and preferences. It can
be useful to look at the ‘trade offs’ between different options.
Describe
options
First describe what each option entails, rather than going straight for
comparing the pros and cons. It is helpful to separate the description
of each option from the discussion of the risks and benefits of each.
If using a BDA then the left hand column usually contains some
factual information about what the option entails. It is not
comprehensive and you may want to add details. The BDA is a
support tool not a script!
If using a blank decision aid – then populate together
Describe risks, This is a key point in shared decision making. It is important to be
consequences systematic and balanced when presenting the risks/benefits of each
&
option.
benefits
Describe the most relevant and common risk or consequence
before describing the benefit. The BDA gives you figures where ever
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And the
chances
(likelihoods) of
these benefits
and risks
Checking in
on
understanding
‘Weave in’
preference
talk when
appropriate
it has been possible to find reliable ones. These are always described
as absolute risks and benefits, and with a common denominator
where possible. You will see they are always balanced statements.
‘Chunking’ and ‘checking’ skills are helpful here. Non-verbal signals
from the patient are very important – check whether you are both
still ‘on the same page’.
Check whether the patient understands what you have told them
about the options.
‘What matters to me’ talk – naturally occurs as you lay out options. It
is important to pick up on this and summarising is a useful skill to
deploy in capturing and consolidating this. – however final
preference talk should be reserved for when you have explored all
the relevant options
3.6 Preference/Decision talk – What is important to me talk
You may well have already picked up quite a lot about ‘what is important to me’ as
you introduce choice and lay out the options. BUT it is important after you have
done this to actively enquire about the values and preferences of the patient as
they assimilate information about options. “What is important to you when you look
at your options and consider the pros and cons of each?”
Core Skill
Summarise &
check
preferred next
step
Pressing on to
decision now?
or
Pausing –
deferring
closure and
allowing for
contemplation
/deliberation
time?
Preference
talk
“Making the
decision that
is right for
you”
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Techniques/Tips
Useful to summarise what you have done and state that you need to
decide together about the options available in light of what is
important to the patient.
Patients who have encountered the ‘choice’ talk and ‘option talk’
might appreciate the fact that they have explored their options but
they might also feel that they are unable to make a decision now.
It is important for the practitioner to explore the patient’s reactions.
Indicate that people sometimes feel overwhelmed, and that time
may be needed for deliberation. It also signals that the practitioner is
also prepared to guide the patient, if that is what they prefer at this
point.
Some patients will choose to defer the decision and to access more
information, especially if the access to such material is facilitated.
There might be a gap where the patient either steps outside the
consultation room to read or to view more material, confer with
others, or where they return/ telephone after they have had time to
deliberate.
This step is the most critical of all and should only be attempted when
it is clear that the patient has had the opportunity to have more
information about the options and has been able to understand the
implications for them.
If you think it would be of assistance, help the patient to explore the
options in terms of what is important to them. Some decision support
materials try to prompt patients by including particular questions –
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NOTE
Preference
talk refers to
values and
attitudes and
not directly to
the
‘preference’
for a
particular
option
Moving to a
decision
attributes/ frequently asked questions/ the things that matter to me.
In the BDA we have a list of ‘Frequently Asked Questions’ at the end.
These FAQs are useful prompts to help patients think about their
preferences.
Patients may have already made it clear that they favour one option
– your task here is to check that they have understood the other
options and their implications. It can be helpful to ask why the patient
is so clear on one option – particularly to check that there are no
misunderstandings.
At this point, patients have been able to state their preferences. It is
important to do final checking at this stage.
Remind the patient that they can have more time to think about it if
they want, the decision does not have to be final, and it may be
reviewed in future. It is sometimes useful to check out feelings and
thoughts e.g. the gut feeling.
This will enable you to arrive at closure.
If there is time we will look at a demonstration of a SDM consultation
1. Demonstration of a SDM consultation – live with pauses and discussion
2. Video demonstration
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Practicing skills – Microskills practice
Your trainer will work with you on skills practice
Variations
Combinations of learners
 In groups of 6 with a standardised patient and all taking turns,
 with trios with an observer,
 or in pairs with just patient and clinician
part or the whole of a consultation
 The whole of the SDM model in single rehearsal or selected
components
With or without decision support material
 Practicing with decision support material and practicing without
decision support material
There are pros and cons to all the above variations – your trainer will work with you to
find the best rehearsal exercises in the current circumstances.
The critical issues in skills practice:
Playing the patient
You will be given a script with some basic information on it. You will almost always be
going from a point in the consultation where the basic nature of the problem has
already been outlined and where you are starting to looking at management of the
problem.
Try and ‘get into the head’ of the patient., but try not to either be the most obliging,
articulate and cooperative patient – but neither try to be the most personality
disordered and awkward patient!
Playing the clinician
This is the opportunity to try out new ways of doing things. If you do not like what you
have just said – start over and practice a different form of words. Do not worry so
much about the content, think more about the process, keeping the SDM model in
mind, and using the checklist to remind yourself of key new skills.
You might like to keep the following questions in mind:
1. How much am I talking, compared to how much is this generating a
conversation??
2. Am I using the decision support as a script or as a way to stimulate dialogue?
3. might it be worth trying just using a blank decision aid and writing things down
as we go?
4. Do I know what matters most to the patient in making this decision?
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Role of the observers:
You are there to help the learner learn (it is your turn in the hot seat soon)! – So what
feedback can you give that will help them? You have a laminated check list of the full range of skills. It might be helpful for you
to have this available during the full rehearsal.
Any phrases or ways of conducting the consultation that you thought were
particularly helpful? – You might want someone in the group to ‘capture’ particularly
useful phrases or ways of saying something. This can be useful to highlight to the
clinician who is in the hot seat
Do not be afraid to stop the consultation and any point when you are stuck – refresh
your memory or re group thoughts and try again – remember this is safe practice
time – use it well!
We hope that you may be able to do 2-3 full rehearsals in the time available
You may like to jot down any learning points you pick up during this final rehearsal
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4. Wrapping up and next steps
Learning points
Spend five minutes jotting down the most important learning from the day so far.
Planning and goal setting
Then in small groups
Are you ready to put down you goals? – have a go at this question:
If we were the best MAGIC team we could be in 1 year’s time – What would
we be doing that we are not doing now?
What are the key components of this MAGIC vision?
What are the next steps for you personally?
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What are the next steps for the team – where will you focus? How will you know it is
helping?
Some final thoughts
By now you should have a much better idea of what a shared decision might look
like and how you might do one. Many of you are doing lots of this work already and
today is about consolidating and refining your skills in this area.
As an individual it is well known that unless you practice a new skill fairly frequently
you are unlikely to add it to you repertoire of ‘automatic’ skills that ‘just happen’.
You need to practice it regularly and to do that you will need to make sure you
have decided when you are going to deploy these techniques and how you will
reliably get the support you need to deliver MAGIC consultations.
Good Luck!
The MAGIC team look forward to hearing how it is going and seeing the feedback
and other data that will help us know what is working and what is not working.
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5. List of key papers
Do patients want a choice and does it work – Coulter 2010
The government in England wants to give patients more choice about their health care.
Angela Coulter argues that treatment choice is more popular with patients than provider
choice, with much greater evidence of benefit.
Do patients want a choice and does it work? Angela Coulter, BMJ 2010;341:c4989
Shared Decision Making: A Model for Clinical Practice - Elwyn et al 2012
The principles of shared decision making are well documented but there is a lack of
guidance about how to accomplish the approach in routine clinical practice. Here is a threestep model that is practical, easy to remember, and can act as a guide to skill development.
Abstract Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording
E, Tomson D, Dodd C, Rollnick S, Edwards A, Barry M, J Gen Intern Med. 2012
October; 27(10): 1361–1367.
Cochrane systematic review of patient decision aids – Stacey et al 2011
Review of the evidence of the benefits of using decision aids for people facing health
treatment or screening decisions.
Full Review Summary of review Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, HolmesRovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R. . Cochrane Database of
Systematic Reviews 2011, Issue 10. Art. No.: CD001431. DOI:
10.1002/14651858.CD001431.pub3.
Negotiating patients' treatment decisions significantly improves adherence to asthma
pharmacotherapy and clinical outcomes.
Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled
Asthma: Wilson et al 2009. Am J Respir Crit Care Med. 2010 March 15; 181(6): 566–577.
Websites
The Health Foundation
Information about the MAGIC SDM Programme and changing relationships between health
professionals and patients. MAGIC - testing how to implement shared-decision-making in
real clinical environments - ‘This is what we do now!’
Resources to help you to implement SDM in your environment. These resources have been
developed as part of the MAGIC Programme. Shared decision making resource centre.
The Patient Decision Aids: NHS Right Care
Shared decision making webpage giving information about SDM, decision coaching and
listing the PDAs available now and in the future.
AQuA: Advancing Quality Alliance
The Advancing Quality Alliance (AQuA) is a health care quality improvement body. Visit their
shared decision making webpages and resources
www.patient.co.uk10 Brief Decision Aids – a pilot project, with plans to extend with 10
further BDAs
www.optiongrid.co.uk/ This site is a resource for a variety of Option Grids designed to
support clinicians and patients in making difficult treatment choices
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Ottawa Health Research Unit: The Patient Decision Aids Research Group was established
in November 1995 to help patients and their health practitioners make "tough" healthcare
decisions.
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