Shared decision making is a process in which clinicians and patients work together to choose tests, treatments, management, or support packages, based on clinical evidence and patients’ informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and systems for recording and implementing patients’ treatment preferences.
The Health Foundation's MAGIC (Making good decisions in collaboration) programme aims to support clinical teams in primary and secondary care to embed shared decision making with patients in their everyday practice. This independent evaluation by the Office for Public Management (OPM) covers the first phase of the programme.
The evaluation shows that, while there are challenges to making shared decision making a reality, and it can be hard and slow to do, shared decision making can create positive change within health systems and to individual patients.
True shared decision making is more than introducing a set of tools. A combination of changes in attitude, skills and infrastructure is required to effectively facilitate shared decision making.
Clinicians can think that they are already doing shared decision making effectively, but once they really understand what it is, they see that it is a lot more than just good communication skills. Training delivered as part of the MAGIC programme enabled people to think differently and demonstrated how shared decision making is different to their current practice, which helped to change attitudes and practice.
It takes time to create culture change and to embed across a system. The evaluation suggests that starting small can support successful implementation – starting with a particular patient group or clinical specialism and then expanding when you are more confident with what you are doing.
The evaluation team also interviewed a number of clinicians and patients to produced seven improvement stories, exploring their experiences of implementing shared decision making in practice. These stories form the basis of our Learning report, Implementing shared decision making.
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