Shared decision making: MAGIC

Overview

People want to be well informed and actively involved in making choices about their own healthcare. In fact, being kept in the dark about their treatment is one of the biggest causes of dissatisfaction among people who use healthcare services.

Shared decision making recognises that while clinicians are the experts about different treatment options available, the individual is also an expert about her or his own circumstances. This includes their personal preferences (what is important to them) and their attitudes to risk. Shared decision making invites clinicians and patients to pool their differing expertise and work together as active partners when making choices about care.

This works particularly well in situations where there is more than one reasonable course of action. Often difficult decisions need to be made based on the amount of risk involved and the potential outcome of each choice.

An example of this would be a woman with early breast cancer deciding between mastectomy and breast conserving surgery. She should be able to make this decision herself, advised and supported by her clinician who will explain all the potential risks and possible outcomes of each choice. A shared decision making approach may be enhanced by effective decision support tools such as decision aids and interactive web programmes.

However, despite strong evidence and a common understanding that shared decision making is good practice, the approach has been slow to spread across the NHS. This is because it’s a big culture shift for the health service and means breaking away from the traditional relationship between ‘passive patients’ and ‘expert health professionals’.

What are we doing?

The Health Foundation is supporting an 18 month programme run by a collaboration between Newcastle and Cardiff Universities, Newcastle-upon-Tyne Hospitals NHS Foundation Trust and Cardiff and Vale Health Board.

Called MAGIC (Making Good Decisions in Collaboration), the programme explores how shared decision making can be embedded into clinical practice as a core part of mainstream health services. The programme is designing and testing interventions to encourage the use of shared decision making. It began in August 2010 and runs until January 2012.

What will the programme involve?

Professor Richard Thomson at Newcastle University and Professor Glyn Elwyn at Cardiff University will together lead a multidisciplinary ‘design team’ made up of senior academics, clinicians and managers.

The team will design and test interventions across a range of sites and clinical areas, including:

• primary care
• obstetrics
• urology
• breast cancer care
• ear, nose and throat.

MAGIC will build practical and transferable knowledge about how shared decision making can become a core characteristic of routine clinical care across the NHS.

The design team will:

• Raise awareness of existing decision support tools which have already been proven to be effective, focusing on the behavioural shift needed to roll out their use.
• Use a range of social marketing techniques to raise awareness of the benefits of shared decision making among service users and staff in each site.
• Use action learning and rapid quality improvement methods to support change.
• Support the process of culture change required for embedding shared decision making by implementing a detailed strategy for engaging clinicians.

The support provided by the Health Foundation covers:

The Health Foundation is supporting  the MAGIC Programme, which will be implemented by the multi-disciplinary design team (see above). We will work closely with the core design team to monitor progress and gather learning throughout the 18 month implementation period.