1. Right Care for Patients The National Shared Decision Making Programme

2. One thing I have always found is that you have got to start with the customer experience and work backwards to the technology. Steve Jobs 1955-2011

3. I wanted to ask questions but did not feel fit to do so at the time. No choice on treatments, even though I asked for the options! Being treated as a person. Treat the person, not the condition!

4. More patient education for the GPs Need to know what to ask for. Get education. Information is at the core of decision making - up to date information, new treatments and patient mentoring. I wanted to know more about the kidneys not just the condition. Cannot make decisions unless I'm informed. Knowledge is power!

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

6. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Whole GroupHigh-Comorbidity Murtagh et al. NDT 2007

7. Choice of Modality 38% 20%

8. Patient Choice Advanced Kidney Disease The BOLDE Project (Brown E.A et al. 2010) Part 1 - Older patients can successfully be dialysed using PD; - Patients on PD perceived significantly less illness and treatment intrusion; - After regression analysis, patients on PD and HD reported similar quality of life. Part 2 - Patients want to be involved with modality decision-making; - The unit with the lowest use of PD had the lowest patient involvement in decision making.

9. UK Renal Registry 13th Annual Report Figure 2.6: Treatment modailty in prevalent RRT patients on 31/12/2009

10. UK Renal Registry 13th Annual Report

11. Variation in UK

12. Shared Decision Making Shared decision-making is a process which involves patients: –as active partners with their clinician; –in clarifying acceptable medical options; –and in choosing a preferred course of clinical care.

13. What are they sharing?

14. Shared Decision Making in the NHS ‘The Government’s ambition is to achieve healthcare outcomes that are among the best in the world.’ ‘ This can only be achieved by involving patients in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone.’ ‘We want the principle of ‘shared decision-making’ to become the norm: no decision about me without me.’

15. The policy context

16. Why shared decision making? The benefits are: Improving patient satisfaction, experience, knowledge; Helping patients make healthcare choices aligned with their personal needs, values and circumstances; Improving clinical outcomes and safety; Achieving the right intervention rate and reducing unwarranted practice variation; Reducing cost and litigation costs.

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

20. The National SDM Programme

21. National Right Care Shared Decision Making Programme Governance Structure (draft)

22. Thank you Management is doing things right; leadership is doing the right things Peter F Drucker steven.laitner@nhs.netsteven.laitner@nhs.net www.rightcare.nhs.uk