The Right Care Shared Decision Making Programme

Dr Steven LaitnerGP and National Clinical Lead for Shared Decision Making

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Why?

%

Wanted more involvement in treatment decisions:

Source: NHS inpatient surveys

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Doctor always gives information about treatment choices and elicits preferences

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Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5.(“wrong patient

error”)

Whole Group High-Comorbidity

Murtagh et al. NDT 2007

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Variation in UK

Awareness is the first important step in identifying and addressing unwarranted variation; if the existence of variation is unknown, the debate about whether it is unwarranted cannot take place.

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Top 30 PCTs(Lowest Rates)

Next 31 PCTs

Next 30 PCTs

Next 31 PCTs

Bottom 30 PCTs (Highest Rates)

Top 30 PCTs(Lowest Rates)

Next 31 PCTs

Next 30 PCTs

Next 31 PCTs

Bottom 30 PCTs (Highest Rates)

Top 30 PCTs(Lowest Rates)

Next 31 PCTs

Next 30 PCTs

Next 31 PCTs

Bottom 30 PCTs (Highest Rates)

London

Variation in knee replacement activity

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Knee replacement satisfaction

• Satisfaction questions were completed by 8095 patients

• Overall- 81.8% were satisfied- 11.2% were unsure- 7.0% were not satisfied

• The OKS varied according to patient satisfaction (p<0.001)

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What are they sharing?

Clinicians Patients

• Experience of illness• Social circumstances• Attitude to risk• Values• Preferences

• Diagnosis• Cause of disease • Prognosis• Treatment options• Outcome probabilities

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NHS Direct Patient Decision Aids

NHS Direct Patient Decision Aids

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A personal approach

Two films developed to support personalisation

For healthcare professionals

And for service users and carers

Evidence base document produced showing• Patient benefit• Clinical benefit• Financial benefit

All available at:www.eoe.nhs.uk/personalisation

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Key messages

• Patients want to be more involved in decisions about their healthcare

• Doctors and nurses need to work better with patients to share the decision-making process. This requires a culture change

• Decision aids and decision support help patients make healthcare decisions which are right for them and right for society

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Thank you

Give people the care they need and no less, the care they want and no more

steven.laitner@nhs.net

www.rightcare.nhs.uk