London 20^th June: Healthcare professionals are positive about shared decision making, a way of working with patients to decide treatment options, states a new report from the charity the Patients Association.

The report is based on the views of 1,416 clinicians and healthcare professionals gathered in an online survey in April and May 2022. The survey found that most respondents said they practised shared decision making always or often. They recognised its benefits and were positive about involving patients in choices about their care.

Chief Executive of the Patients Association, Rachel Power, said: “The survey’s findings are great news. Doctors, nurses, and other health professionals are positive about partnering with patients to make decisions about treatment. We believe working in partnership is the way to achieve better outcomes for patients and also the NHS.”

But professionals’ ability to practice shared decision making regularly is limited at the moment by the current crisis in the NHS. Many respondents said lack of time, gaps in the workforce or large caseloads prevented them partnering with patients in this way. Problems with NHS IT were also mentioned as a major barrier.

Attitudes to shared decision making

• More than 1 in 3 of respondents said that they always practised all three of the core elements of shared decision making;[1] 2 in 5 said that they often did.
• Nine out of ten respondents said shared decision making should be used routinely.
• Nurses were the professional group most positive about shared decision making, with specialist nurses being the most positive of all respondents.

Barriers to practising shared decision making

• One in four respondents said lack of time was the biggest single barrier to practising shared decision making.
• Just over 1 in 10 said better IT systems would help.
• Just under 1 in 10 said more staff would make it easier for them to practice shared decision making.

Training

• Nurses were more likely to have had shared decision making as part of their training than doctors.
• Respondents whose initial training did not include shared decision making are more likely to have a gap in their knowledge all through their career; later, in-career training does not fully compensate.

Professor Dame Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges, said: “The findings show that there is little debate among clinicians about the value and relevance of shared decision making. The issues are really about how to support and increase its practice.

“The Patients Association’s recommendations on better promotion of shared decision making, greater use of tools and improving training are spot on, as is the call on NHS Digital to ensure IT systems can best support professionals to work in this way.”

Professor Alf Collins, Clinical Director of NHS England’s Personalised Care Group, said: “This report will really help inform our thinking in NHS England and Improvement.

“It's pleasing to see almost universal enthusiasm for shared decision making among clinicians and it's particularly important for us to recognise the systemic barriers to adoption that the report has highlighted.

“We acknowledge that IT systems can be a significant challenge when it comes to recording patient preferences and we hope that the new shared decision making standard[2] will go some way towards helping with this issue.

“We also acknowledge that decision-support tools are not as easy to access as they could be; the Personalised Care Institute will, in the next few weeks, host a small number of NICE-compliant tools that we hope colleagues will find useful.”

Professor Martin Marshall, Co-Chair of the Personalised Care Institute, commented: “It’s good to see such positive support from clinicians for shared decision making, despite their workload and the workforce pressures they are currently working under.

“The report identifies a number of challenges for clinicians when it comes to delivering shared decision making and these must be addressed. It also shows that personalised care leads to better patient outcomes and improved experiences for patients and clinicians, so it is something we must strive for.

 “The Personalised Care Institute (PCI) was established to support the health and care workforce to embed personalised care into their daily practice. Since developing the first ever curriculum for personalised care, the PCI has launched a range of free quality-assured eLearning modules and more than 100 courses and resources, including many on shared decision making.

“It is now working alongside NHS England and more than 40 partners and institutes to encourage clinicians from every profession to engage in personalised care learning. This report suggests that its work exploring ways of introducing personalised care education - particularly shared decision making - into undergraduate settings and early career pathways could also be very important.”

Andrea Sutcliffe CBE, Chief Executive and Registrar at the Nursing and Midwifery Council (NMC), said: “Working together to provide person-centred and tailored care is an essential part of how health and care professionals meet people’s needs. The NMC Code and standards support nurses, midwives, and nursing associates to listen and empower people to participate in decisions about their care.

“Through this report, it’s encouraging to see just how keen and proud our professionals are to work in partnership and deliver person-centred care in this way. The report also makes clear how important it is that they have the time and resources to do so effectively.”

Heather Moses, Country Medical Director, Novartis UK, said: “This new research by the Patients Association gives valuable insights to all of us about how to best support patients. Shared decision making is an integral part of good healthcare, and a key factor in securing better patient outcomes.

“Novartis is committed to working in partnership with NHS and other stakeholders to help address barriers and continue to support patients to take a wider role in decisions about their care.”

The Patients Association recommendations

• The NHS should enhance and make more consistent the promotion of shared decision making approaches.
• The NHS should make a co-ordinated effort to promote existing resources and good practice to its workforce.
  • But any promotion must recognise the circumstances where shared decision making may not be appropriate.
• Gaps in decision support and patient information that cannot be filled by promoting existing materials and good practice should be identified and remedied.
• NHS Digital should examine IT shortcomings and ensure that its future efforts to improve the IT capacity in the NHS includes ensuring new systems support shared decision making.
• Curriculums for healthcare professionals should be reviewed and, where necessary, enhanced to ensure shared decision making is taught. No clinician or healthcare professional should be able to qualify to practise without having been taught fully about shared decision making. In-career training does not appear to sufficiently fill any gaps.

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For more information please contact [email protected]

Notes for editors

The Patients Association survey into shared decision making was conducted online from April 25^th to May 17^th, 2022. We commissioned Wilmington Healthcare to send emails inviting 40,000 clinicians and professionals to take part, comprised of 6,600 practice nurses – as many as are on Wilmington’s database – and the rest split evenly between GPs, specialist nurses and hospital doctors.

The invitation to participate came from the Chief Executive of the Patients Association, Rachel Power, and the Chair of the Academy of Medical Royal Colleges, Professor Dame Helen Stokes-Lampard.

We received 1,416 responses.

The full report, Shared decision making from the perspective of clinicians and healthcare professionals, along with details of the methodology, sample, full results tables for all questions are available on our website.  The report has full details of our recommendations.

The survey was supported by Novartis, which had no input into the development and distribution of the survey, and no influence over the content of the report.

About the Patients Association

The Patients Association’s purpose is to ensure that everybody can access the health and care they need to live well, by ensuring that services are designed and delivered through equal partnership with patients. It is an independent charity.

[1] Provide the patient with evidence-based information outlining treatment, care or support options, outcomes and uncertainties; Provide the patient with decision support counselling to clarify options and preferences, either yourself or via a colleague; Use a system for recording, communicating and implementing the patient’s preferences.

[2] Professional Records Standards Body. Shared decision making. Available from: https://theprsb.org/shareddecisionmaking/ Last accessed: June 2022.

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