Shared decision making: shared reality or insider jargon?

Shared decision making: shared reality or insider jargon?
Patients Association 16 July 2021

• This report explores progress to date in shared decision making, and the extent to which it is a reality for patients. It identifies barriers to the adoption of shared decision making, and points the way towards -ways that might remove them in the future.

Shared Decision Making [NG197]

Shared decision making
NICE [NG197] 17 June 2021

• This guideline covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and people using services to work together to make decisions about treatment and care. It includes recommendations on training, communicating risks, benefits and consequences, using decision aids, and how to embed shared decision making in organisational culture and practices.

Conversations for ethically complex care

Conversations for ethically complex care
Royal College of Physicians 9 February 2021.

• A framework to support discussion and documentation of decision making for levels of care in clinical practice.

Promise and perils of patient decision aids for reducing low-value care

Promise and perils of patient decision aids for reducing low-value care
BMJ Quality & Safety : 24 December 2020. doi: 10.1136/bmjqs-2020-012312

• A discussion of patient decision aids which aim to reduce the use of care considered of low value.

Shared Decision Making for patients on surgical waiting list

Shared Decision Making for patients on surgical waiting list Infographic
NHS England 1 October 2020

• Part of the Guidance: Clinical Validation of Surgical Waiting Lists: framework and support tools

The Use of Patient-Reported Outcome Measures to Guide Referral for Hip and Knee Arthroplasty

The Use of Patient-Reported Outcome Measures to Guide Referral for Hip and Knee Arthroplasty
Bone Joint J . 2020 Jul;102-B(7):941-949. doi: 10.1302/0301-620X.102B7.BJJ-2019-0102.R2.

• Existing UK data from 222,933 knee and 209,760 hip arthroplasty patients were used to model an individual's probability of gaining meaningful improvement after surgery based on their preoperative Oxford Knee or Hip Score (OKS/OHS). The findings are useful to support the shared decision-making process in primary care for referral to secondary care; and in secondary care for experienced clinicians counselling patients considering knee or hip arthroplasty.

A pre-post study of providers' experience with artificial intelligence-based clinical decision support

A lesson in implementation: A pre-post study of providers' experience with artificial intelligence-based clinical decision support.
Int J Med Inform. May 2020;137:104072. doi:10.1016/j.ijmedinf.2019.104072

• A survey of  explore attitudes about artificial intelligence (AI) among staff before (n=45) and after (n=38) using an AI-based clinical decision support (CDS) in three [US] primary care outpatient clinics. The CDS identified patients at risk for poor glycaemic control and generated intervention recommendations intended to reduce patients’ risk. 
• Only 14 % of users would recommend the AI-based CDS. Staff feedback revealed that the most favourable aspect of the CDS was that it promoted team dialog about patient needs (N = 14, 52 %), and the least favourable aspect was inadequacy of the interventions recommended by the CDS.

Abstract

Shared decision making for thromboembolic prophylaxis in non-valvular atrial fibrillation: promise and problems

Shared decision making for thromboembolic prophylaxis in non-valvular atrial fibrillation: promise and problems with the American College of Cardiology’s AnticoagEvaluator (based on SPARCtool)
BMJ Evidence-Based Medicine 2020;25:90-96
An evaluation of the American College of Cardiology ‘AnticoagEvaluator’shared decision making tool (based on Peter Loewen’s ‘SPARCtool’) for deciding on an antithromboembolic strategy in non-valvular atrial fibrillation found that it gives misleading impressions of therapeutic efficacy.

Abstract

Problem with patient decision aids

Problem with patient decision aids
BMJ Evidence-Based Medicine 21 May 2020. doi: 10.1136/bmjebm-2020-111371

• An exploration of the issues around guidelines for developing patient decision aids and bias presentation of low certainty evidence to support patient decision aids.

Abstract

Understanding the public’s role in reducing low-value care: a scoping review.

Understanding the public’s role in reducing low-value care: a scoping review.
Implementation Sci 15, 20 (7 April 2020). https://doi.org/10.1186/s13012-020-00986-0

• The objective of this scoping review was to systematically examine the literature describing public involvement in initiatives to reduce low-value care.The majority of included citations were published following inception of Choosing Wisely in 2012. 
• Of the 218 studies identified 156 (72%) focused on patient engagement within the patient-clinician interaction, using tools that included shared decision-making (n = 66, 42%) and patient-targeted educational materials (n = 72, 46%), and reported both reductions in low-value care and improved patient perceptions regarding low-value care. Thirty three studies (15%) examined public involvement in low-value care policy-making. Forty one studies were from Europe.

Abstract