Last summer, we said research was needed to identify whether practising shared decision making took more time in clinical appointments, than other styles of working.

Our latest report, Shared decision making from the perspective of clinicians and healthcare professionals, answers that question.

Based on the answers of more than 1,400 professionals our report shows doctors, nurses, GPs, and other clinicians regularly practise shared decision making, believe it’s an appropriate way to work together with most patients, and are optimistic that it will be easier in the future to work in this way.

For the full report, click here.

The findings

What clinicians and professionals think about shared decision making

Respondents recognised the benefits of shared decision making and were positive about involving patients in choices about their care.

Training

Shared decision making was not prominent in most respondents’ initial training but was or is a part of their in-career training and continuing professional development.

The difference between doctors and nurses

Nurses received more training, were more open to learning more during their career, and were more positive about shared decision making than doctors.

Is shared decision making always appropriate?

The answer was not always. Respondents mentioned examples such as an unconscious patient in intensive care.

Time needed for shared decision making

Respondents said shared decision making takes more time than traditional care in initial appointments. But views were much more mixed about whether it saves time later in a patient’s care or continues to be more time-consuming.

The barriers

The NHS crisis

Respondents were clear: the NHS is under-resourced to conduct shared decision making. They reported lacking time, not enough staff, and excessively high caseloads. Very clearly, there is little prospect of shared decision making becoming a reality for most patients while the NHS is in its current state of crisis.

IT systems

The NHS’s IT systems are a barrier to recording, communicating, and implementing a patient’s preference. Respondents were frustrated that the IT systems are hard to use, are unreliable, and do not integrate with each other.

Information and aids

Respondents want more and better information to give patients, as well as tools and aids to help in shared decision making. Also, these tools and aids should be promoted more widely to encourage their use.

The impact of COVID-19

Respondents had mixed views about whether shared decision making had become harder during the pandemic, or if it had been unaffected. Providing information to patients and supporting them to work through decisions in particular divided opinion, although most agreed the pandemic made no difference to how easy it is to record patients’ decisions.

But there was a surprising amount of optimism about shared decision making becoming easier in the future.

Our recommendations

  • Discuss the resourcing of the health and social care system from the patient perspective. Our report makes clear there are substantial resource barriers to patients being able to participate fully in decisions about their care, and, therefore, to reaching the best decision for them. The current crisis in the NHS must be understood in terms of patient involvement and experience, as well as the delivery or non-delivery of treatment. Shared decision making cannot be delivered consistently while the NHS is under its current resource limits.
  • The promotion of shared decision making approaches within the NHS should be enhanced and made more consistent.
  • The NHS should promote existing resources and good practice to its workforce: a co-ordinated programme across the whole NHS is need.
  • 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 weaknesses and ensure that its future efforts to improve NHS IT include work to ensure new systems are helpful for shared decision making.
  • All organisations promoting shared decision making should ensure that they do so with flexibility.
  • No clinician or healthcare professional should be able to qualify to practise without having been taught fully about shared decision making. All relevant curriculums should be reviewed and, where necessary, enhanced.
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