Shared decision making - what is it?

Why is shared decision making important?

Shared decision making is very different from saying ‘yes’ or ‘no’ to a particular test or treatment that a healthcare professional suggests for you. Instead, you and your healthcare professional reach decisions about a treatment or a test together. You both have a shared understanding of your condition, the treatment options available to you and the risks and benefits associated with each of those.

It allows you to be more involved in making decisions about your own health and healthcare. For many conditions, there is one treatment that has been shown to be effective above all others and, in these cases, most people are happy to be guided by their healthcare professional. However, in many cases, there is more than one treatment option available and there is no set clinical evidence to say which is better. This is when shared decision making comes into play.

Healthcare professionals, whatever discipline they have trained in, are experts in their field. But they aren’t an expert on you, your values and beliefs, or how you view risk. When making decisions about your healthcare, all these elements are important to consider. Shared decision making allows you to balance the benefit of a treatment against the risks and can therefore help to reduce potential side-effects and harm.

There is evidence to suggest that if you actively take part in managing your health and care, you will have better outcomes than people who don’t. Shared decision making can also reduce how many people choose to have certain tests (such as a PSA test for prostate cancer) because they become aware of any associated risks.

When is shared decision making appropriate to use?

Shared decision making can be used to make any choice about your healthcare. For example, it’s appropriate for decisions about whether to:

  • have a screening or diagnostic test
  • have a medical or surgical procedure
  • take medication
  • attempt a lifestyle change

What is my healthcare professional’s role?

Shared decision making is becoming more and more encouraged. When it comes to decisions about your healthcare, both you and your healthcare professional should contribute. His or her role is to:

  • inform you about your condition and the test, treatment or support options that are available
  • inform you about the benefits and risks of each treatment option or test
  • ensure that you both come to a decision based on mutual understanding
  • record and implement the decision reached

What are decision aids?

To be able to play your part in the decision making process, you need to be well informed about your condition and the test and treatment options that are available to you. Your healthcare professional can talk to you about these and explain the pros and cons of each option. However, having enough time to talk through everything during an appointment can often be challenging. It’s sometimes best to go away armed with information about your options and read over them in your own time at home. For many conditions, there are decision aids available to help you consider your options.

Decision aids are similar to clinical guidelines, as they are based on clinical evidence; however, they don't tell you what to do. They are specifically designed to help you think about your different options and which one is right for you. Decision aids allow you to be informed, so you can make a decision alongside your healthcare professional. They can come in a variety of forms, ranging from a one page sheet outlining treatment options to interactive websites.

Top tips for successful shared decision making

  • Before you go to an appointment, do your homework. Research your condition and make a list of questions to ask your healthcare professional if you’re unsure about anything.
  • Listen to your healthcare professional’s advice, but make sure you ask questions and voice any concerns.
  • If your healthcare professional suggests that you have a specific treatment or test, ask for further information about the risks and benefits. It’s his or her job to explain these to you.
  • If you’re unsure about anything, go away and research your test or treatment options further.
  • Ask your healthcare professional if there is any information, reading material or decision aids available to take away.

Examples of shared decision making

Deciding about having a tonsillectomy

Sue takes her daughter, Katie, aged 11, to the doctors because she keeps getting frequent attacks of tonsillitis and is therefore missing school. Sue is keen for Katie to have her tonsils removed (tonsillectomy) and believes it will solve the problem. Katie’s doctor explains to Sue that a tonsillectomy could help, but also that attacks of tonsillitis get less frequent as children get older, so it might be a better idea not to operate. Katie’s doctor also explains that there is a risk of severe bleeding after the operation. Sue was unaware of this risk factor and starts to have second thoughts about Katie having her tonsils removed. Katie’s doctor gives Sue a tonsillectomy option grid (a tool to help people take part in making decisions) and tells her to take it away, read over it and consider this information before making a decision.

Deciding about having knee replacement surgery

John is 55 and has knee arthritis. It’s causing him a lot of discomfort and pain. John has heard about knee replacement surgery and is very keen to have it. He sees his doctor, who tells them that there are several treatments options he could consider other than surgery. Non-surgical options include lifestyle changes such as light exercise, medicine and injections to relieve the pain, and physiotherapy. John’s doctor takes his time to explain that surgery isn’t always the best option and there are certain risks involved. He makes it clear that a knee replacement is major surgery and carries risks such as wound infection. It isn’t always successful and some people don’t always feel a great benefit following surgery. John now decides to go away and find out more about knee arthritis treatment options before making his mind up.

Deciding about having a PSA screening test

Roger is 60 years old and is considering having a PSA (prostate specific antigen) test. He has heard about the test and believes it can tell him whether he has the early stages of prostate cancer or not. Roger books an appointment with his doctor to request to have the test. His doctor explains to him that this test measures his blood level of PSA, a protein which is produced by his prostate gland. The higher his PSA level, the more likely it is that Roger has prostate cancer. However, he informs Roger that a raised PSA level can often be caused by something much less serious, such as an enlarged prostate or an infection. Roger’s doctor points out that some men who have prostate cancer will have a normal PSA result. He also highlights that prostate cancer can often grow extremely slowly and may never cause him any problems, so Roger should also consider not having the test. Roger was unaware that the test can be unreliable and decides to go home with a leaflet on PSA testing and discuss the pros and cons of having the test with his wife.

Find out more about having a PSA test from our Bupa experts.