A simple tool to facilitate shared decisions

The Health Foundation’s MAGIC programme has been examining how best to enable and embed shared decision making in the NHS. Here, Dr Marie-Anne Durand, and Professor Glyn Elwyn, from the MAGIC Option Grids Collaborative, explain the value of Option Grids as decision aids and talk us through how to use one.

What are Option Grids?

Option Grids are one page evidence-based decision aids that present a menu of treatment options and compare their potential benefits and risks. They are designed to be used during a consultation to help patients explore and choose the best course of action for their condition.

This is an example of an Option Grid used to support decisions following a breast cancer diagnosis. It compares the risks and benefits of a mastectomy versus a lumpectomy with radiotherapy, using the most up to date evidence about survival rates, recovery time and chances of the cancer returning. It also raises and answers the questions that patients frequently ask about treatment options.

Tools like this help make options more visible for patients. They also provide a structure which makes it easier for clinicians to encourage shared decision making and understand the individual preferences of each patient. Importantly they empower patients by giving them the capacity to make their own choices¹.

A positive impact

These tools are not enough on their own and are designed for use during face to face consultations as part of a shared decision making approach².

When used collaboratively Option Grids can enhance patients’ confidence and voice, and increase their participation in decision making. In fact, a Cochrane review showed that in 86 trials, the use of decision aids increased patients’ knowledge and risk perception, often leading to more informed choices in line with their preferences. In some cases this also reduced rates of elective surgery, therefore cutting costs.

The MAGIC programme is routinely trialling Option Grids for a range of conditions (including breast cancer, tonsillectomy, and head and neck cancer), and has shown that they can:

• standardise the provision of information, facilitate patients’ understanding of treatment options, and make consultations easier
• help patients visualise the difference between treatment options
• operationalise shared decision making, by acting as an aide mémoire for experienced staff and a training tool for junior staff.

How to use an Option Grid

Clinicians should follow five simple steps to make the best use of an Option Grid in a consultation about treatment or screening options:

Step 1: Explain and introduce the Option Grid

Introduce the tool and explain that it is a summary of the reasonable options available. Explain that the FAQ layout allows quick comparison across the options, using questions frequently asked by patients.

Step 2: Check they are willing to read it?

Check whether the patient is willing and/or able to read the Option Grid, or whether they want you to explain the options.

Step 3: Handover the grid and provide a pen

Give the Option Grid to the patient and offer them a pen so that they can jot down questions or highlight the issues that matter most to them. This handover is significant as it shows the clinician considers the patient an equal partner in the decision making process.

Step 4: Create space for them to read

Typically, patients need up to three minutes to read the grid. Ask permission to perform another task while they read (eg enter notes on the computer), so that they don’t feel observed or rushed and can absorb the information. Remain silent until the patient indicates they are ready to discuss the grid.

Step 5: Let’s discuss

Encourage the patient to ask questions and to discuss the options with you. Make it clear you are willing to answer any questions or provide explanations. Let the patient take the grid away with them as an aide mémoire and to help them discuss their options with others if they need to.

Find out more

• About MAGIC
• Examples of Option Grids
• Prepare to Share (shared decision making skills training)

References

1. Elwyn G, Lloyd A, Joseph-Williams N, Cording E, Thomson R, Durand M-A, et al. 2012a. Option Grids: Shared decision making made easier. Patient Education and Counseling In press.
2. Elwyn, G., Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, Cording E, et al. 2012b. How to do shared decision making: a model for clinical practice. Journal of General Internal Medicine In press.