The Right Care Shared Decision Making Programme Dr Steven Laitner GP and National Clinical Lead for Shared Decision Making

2 What is shared decision making? Shared decision-making is a process in which patients are: involved as active partners with their clinician in clarifying acceptable medical options and choosing a preferred course of clinical care.

3 What are they sharing? CliniciansPatients Experience of illness Social circumstances Attitude to risk Values Preferences Diagnosis Cause of disease Prognosis Treatment options Outcome probabilities

4 4

5 Why? % Wanted more involvement in treatment decisions: Source: NHS inpatient surveys

6 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)

7 Variation in UK

8 Hip Replacement When analysed by PCT boundary, the variation in rates of expenditure for cemented primary hip replacement per 1000 population is 16-fold. The rate of expenditure for uncemented primary hip replacement per 1000 population also varies substantially among PCTs at greater than 30-fold

9 Rate of anterior cruciate ligament reconstruction expenditure per 1000 population by PCT Weighted by age, sex, and need; 2008/09 The variation among PCTs in the rate of expenditure for anterior cruciate ligament reconstruction per 1000 population is 50-fold. in Sweden, reported in the New England Journal of Medicine, where it was found that: “a strategy of rehabilitation plus early cruciate ligament repair was not superior to a strategy of rehabilitation plus optional delayed reconstruction. The latter strategy substantially reduced the frequency of surgical reconstructions” Frobell RB et al. New England Journal of Medicine 2010: 363;

10 London Variation in knee replacement activity

11 A New Paradigm for Demand Management? Supporting individuals so that they may make rational health and medical decisions based on a consideration of benefits and risks (for them!)……… …and their values and preferences

12 Decision Aids reduce rates of discretionary surgery RR=0.76 (0.6, 0.9) O’Connor et al., Cochrane Library, 2009

13 The policy context

Commissioning for Value QIPP | Right Care RIGHT CARE FOR POPULATIONS NHS Atlas of Variation Population Planning and Programme Budgeting Accountable Integrated Systems of Care RIGHT CARE FOR PATIENTS Shared Decision Making

15 NHS Direct Patient Decision Aids

16

17

18

19

20

21 Patient Comments: "All the necessary information was there in simple illustrative manner" “Easy to follow and explained in simply in plain English“ “I have an understanding of what I want to get across to the consultant” "Own time, own space, own pace"

22

23 Patient Decision Aids Phases Phase Healthcare Decision Addressed by the Patient Decision Aid Current Status or Expected Launch Date 1Osteoarthritis of the kneeRolled-out since February BPHRolled-out since February Localised prostate cancerRolled-out since February Breast cancer surgery choicesRolled-out since August Chorionic villus sampling/amniocentesisRolled-out since August Prostate Specific Antigen (PSA) testingRolled-out since August Osteoarthritis of the hipRolled-out since August Cataract surgeryRolled-out since August Advanced kidney disease (end of life care plan)Autumn launch date TBC

24 Patient Decision Aids To be developed over the next 24 months Healthcare Decision Addressed by the Patient Decision Aid Abdominal aortic aneurysm screening and repair End stage renal failure Multiple sclerosis Serous otitis media Sciatica Chronic obstructive pulmonary disease (COPD) Stable angina Inguinal and umbilical hernia Cholecystitis acute or recurrent Non insulin dependent diabetes Carpal tunnel syndrome Menorrhagia/ menstrual disorders Recurrent tonsillitis End of life care Atrial fibrillation Obesity

25 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

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