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MAGIC: Shared decision making

In brief

Healthcare is changing. More and more people are asking to know more about their healthcare choices. They want information and the chance to have a say about their care. Shared decision making is a collaborative process in which patients are supported by their healthcare professional to select which of the available options they wish to choose. It brings together in the consultation, or conversations the best scientific evidence and the patient’s values and preferences - which themselves are informed by their beliefs, personal constructs and their personal circumstance, including their age, family and social relationships etc.

Shared decision making has great potential to give individuals higher quality healthcare. It takes advantage of clinicians as experts on treatment options, and puts the individual in the driver’s seat to consider what’s important to them: their circumstances, personal values, and attitude to risk. While there is good evidence that it works, it is a big culture shift from the traditional ‘passive patient and expert health professional’ style of care that many people are used to.

We think shared decision making can make an excellent contribution to improving the quality of UK healthcare. People are more motivated to take advice and follow treatment plans when they understand the reasons and thinking behind their care, so treatment is more successful. Plus there are strong economic benefits. Research shows that when given the right support and information, patients usually choose more cost effective options.

So, we’ve done our research and looked at how good practice can be implemented on a wider scale. Now, with help from shared decision making experts, we are taking steps to see it embraced throughout the NHS.

Our MAGIC programme is working with frontline health professionals and their priority projects across the UK to test how to embed best practice and overcome the barriers to change. We are more than two years into the programme and are seeing some interesting and inspiring results. We think we’re on our way to making healthcare more patient-centred and influencing more healthcare professionals to give patients the choice and involvement they are asking for.

I applaud this initiative. In evaluating tools however it will be easy to miss the tools already being used by patients themselves. One such tool is BaseLine© which is endorsed by the NHSI for use by clinicians and managers when monitoring and improving the performance of critical processes, pathways and commissioning interventions. It is now being adapted for use by patients and will be tested later next year by EMIS in GP Practice trials. More than trying to empower clinicians and patients, the tool enables individuals to self-empower. By following this link you will be able to see two patient case studies where patients are using BaseLine© to transform the conversation they have with their physician – and their outcomes.
The paper incidentally is also a polemic that argues not just for wider patient access to their physician’s notes, but also for the joint creation of those notes.
Shared decision-making is important and I support the Health Foundation in the good work they are doing in this area. I think there is still a lack of clarity about what ‘shared decision-making’ means, and to whom.

I perceive an underlying tension between lay understandings, current practice ‘norms’, and health policy. In particular, uncertainties remain both about the process of shared decision-making, and definition of suitable outcomes (see

Given that, from April 2013, Clinical Commissioning Groups will be tasked with promoting shared decision-making, we need a very clear understanding of what ‘shared decision-making’ means to patients, clinicians, and the DOH. A constructive discussion that acknowledges some of these uncertainties might be helpful, and could assist us in promoting effective patient choice and better healthcare outcomes.
Shared decison making can only begin to work if the patient trusts the clinician and knows that the clinician is not passing judgement - take the area of substance misuse or 'challenging' patients. Unpick this area and you will discover a concerning degree of a lack of trust that drives poor outcomes. Patients very quickly work out from body language, tone etc, whether they are going to be listened to. If the first 15 seconds fail the patient, then no amount of structured decison making is going to work. MAGIC only works if you have established trust.
Dear Nadeem

Thanks for your comment which I have forwarded onto our Magic teams for interest.

You may also be interested in our Closing the Gap project which focuses on Shared Decision Making in Child and Adolescent Mental Health Services. Please see the link below:
Last evening prior to a movie I was discussing the situation of my companion's mother. Her mother had broken a hip and her doctor wanted to call in a surgeon to repair it. This path was overruled by my companion's daughter, a doctor, so the mother was placed in Hospice and died peacefully 10 days later. Without the knowledge of a person with experience in prognosis, most people in this situation would follow the advice of the doctor, and probably be the worse for it. My thought is that the patient-centered care is also about developing autonomy in patients so they do feel comfortable in making decision concerning their healthcare, but in addition, health care providers may be more forthcoming in explaining the likely consequences of decisions on courses of treatments.

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