Module 1: NICE Shared Decision Making

Question 1

What is shared decision making?

Answer 1

A collaborative approach where patient and their HCP work together.

Question 2

What are the benefits of shared decision making?

Answer 2

1. Greater patient satisfaction, understanding and experience.
2. Better communication, trust and patient feeling heard.
3. Better patient concordance with treatment plan.

Question 3

How should shared decision making be implemented within a department?

Answer 3

From the top down.

Identify senior staff to be trained who will then provide training in their department to others.

(i.e. senior leader and board member, patient director, senior professionals and service user to champion shared decision making).

Question 4

In what order within the hospital should shared decision making be implemented?

Answer 4

First implement in easiest area, then next easiest…

Question 5

How should people be trained?

Answer 5

At induction and as part of continued learning.

include train-the-trainer sessions and practical training.

Allow access to clinical supervision.

Question 6

What does the 3 talk model include?

Answer 6

• Introducing choice
• Describe options
• Help explore preferences and come to decision.

Question 7

What factors should shared decision making involve?

Answer 7

• What is important to the patient?
• 3 talk model.
• appropriate language.
• discuss their options (including doing nothing).
• Offer interventions at different stages.
• Tailor methods to patient and setting.
• Use high quality and reliable sources.

Question 8

How should the consultation be structured?

Answer 8

1. With an agreed agenda.
2. Ensure patient knows they can be fully involved.
3. Chunk and check.
4. Teach back technique.
5. Time to make decision.
6. Recap decisions at the end.
7. Record decisions.
8. Patients CAN change their mind.

Question 9

How should risk, benefits and consequences be communicated to the patient?

Answer 9

Personalised.

Mix of numbers, words and pictures.

Risk terms may have different meanings for different people.

Use absolute rather than relative risk.

Use natural frequencies (eg 1:100 rather than 1%).

Same denominator when comparing risk.

Positive and negative framing (eg 97 good outcome, 3 bad).

Question 10

What is the Montgomery rulling?

Answer 10

2015
Protect right to make decisions.
HCP must discuss risks and benefits of each option that are important to that patient.

Consent must be obtained before interfering with bodily integrity.

Consent should only be taken after shared decision making and decision was informed.

Question 11

What does the GMC say regarding consent?

Answer 11

That risks and benefits that the patient considers significant for any reason, should be discussed.

Also should discuss risk of serious harm regardless of how unlikely.