Session II: implications for clinical practice

3. Shared decision making

Glyn Elwyn

Senior Lecturer in General Practice, University of Wales College of Medicine

The “old style” of decision-making in healthcare is shifting from patients merely accepting decisions made by professionals toward patients making their own informed choices. It was argued by Dr Elwyn that a better solution, to enable all parties to feel comfortable, is shared decision making.

Patients are becoming more active in managing their health, and are presented with more potential interventions for which they need to assess their level of need, or risk, such as screening programmes and predictive genetic testing. The key for patients considering such options is that they should be involved in decision making “… to the extent that they desire. ”

Dr Elwyn outlined the skills needed in a practitioner to facilitate shared decision making. They include clearly defining the problem and the options available, and crucially, checking the understanding of the patient and exploring with them their ideas, concerns and expectations. If a decision cannot be reached immediately, practitioners should be open to deferring to a later date and discussions should always culminate in a review of what has been said.

It was acknowledged that practitioners deal with several sources of uncertainty in clinical encounters. Collective and individual professional uncertainty can be addressed through research and professional education (and decision support) respectively. However, the irreducible chance element that arises in discussions about, for example, a patient’s family history and subsequent treatment options, leads to the requirement for effective risk communication. This subject was explored by the next speaker, Dr Adrian Edwards.