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How to embed Shared Decision Making


What Good SDM looks like in organisations:

Why do it?

Through Shared Decision Making (SDM), people are supported to understand their care, treatment, and the support options available - and the risks, benefits and consequences of those options - so they can make an informed decision about their preferred course of action. Shared decision making is appropriate when someone needs to make a decision about treatment when there is more than one option available (including no-treatment options).

There is growing evidence that patient participation in discussions (that they fully understand) improves outcomes, improves patient and staff satisfaction. It facilitates self-management and self-care and reduces complications. It is also a useful strategy for tackling over-diagnosis and over-treatment. SDM ensures that individuals are (Hoffman, 2017):

  • supported to make decisions based on their personal preferences 
  • more likely to adhere to evidence-based treatment regimes
  • more likely to have improved outcomes, and 
  • less likely to regret the decisions that are made. 

(For facts and figures on the benefits of personalisation, see The Evidence for Personalised Care.)


It is a legal requirement for health professionals to take: 

  •  “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment and of any reasonable alternative or variant treatments”. (Health and Social Care Act 2012, Medical Protection Society 2015, Montgomery v Lanarkshire Health Board (Scotland) 2015 UK Supreme Court.)
  • Principle 4 of the NHS Constitution states that:

“The NHS aspires to put patients at the heart of everything it does. It should support individuals to promote and manage their own health. NHS services must reflect, and should be coordinated around and tailored to, the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. The NHS will actively encourage feedback from the public, patients and staff, welcome it and use it to improve its services.”



It is intrinsic in professional codes:


‘Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.’




32. You must give patients the information they want or need to know in a way they can understand. 
49. You must work in partnership with patients, sharing with them the information they will need to make decisions about their care



2 Listen to people and respond to their preferences and concerns 
To achieve this, you must: 
2.2 recognise and respect the contribution that people can make to their own health and wellbeing 
2.3 encourage and empower people to share in decisions about their treatment and care 



1.2 You must work in partnership with service users and carers, involving them, where appropriate, in decisions about the care, treatment or other services to be provided.
1.3 You must encourage and help service users, where appropriate, to maintain their own health and well-being, and support them so they can make informed decisions.



How to do it

Have a look at the video below from Bristol Community Healthcare Trust, featuring patients and SDM conversations. Using the diagram above and the links to tools and resources in the blue boxes below, review the following steps:

Supportive Systems and Processes

1) Benchmark SDM standards within your service/organisation – identify appropriate measurement tools. (Try the Implementation Checklist and the SDMQ9 and CollabORATE tools from the Supportive Systems box below.)
2) Benchmark leadership support for SDM and Personalised care. 
3) Work with the C&W Programme Team to promote best practice.

Trained Teams

1) Benchmark SDM within your professional practice and identify areas for development. 
2) Assess and promote appropriate training, available for individuals and teams. (Visit our Training and Development page for ideas.)
3) Work with the C&W Programme Team to promote best practice and access any appropriate bespoke training for individuals and teams.


Commissioned Services

1) Map your patient pathways and use the toolkit to benchmark SDM within them.
2) Identify where personalisation should be embedded, and what needs to be put in place to facilitate this.
3) Work with the C&W Personalisation Programme Team to promote best practice and access any appropriate toolkits.


Prepared People and Patients

1) Benchmark patients’ current perceptions of involvement in SDM. Where appropriate, use Patient Activation tools with patients. (You can find some in the 'Resources for Preparing Patients' box below.)
2) Assess and introduce SDMQ9 or CollaBORATE to your practice. 
3) Assess and use the freely available Decision Aids and other materials for use with patients in order to help them with shared decision making. (This guide to selecting Decision Aids is very useful.)
4) Where appropriate, use Easy Read versions of materials. 
5) Instigate regular reviews of your selected assessment findings (SDMQ9 or CollaBORATE).

Bristol Community Healthcare Trust and SDM conversations with patients

Bristol Community Healthcare Trust produced a video illustrating Shared Decision Making in action. Two patients and their healthcare professionals tell their stories about the difference SDM has made to them. Claire describes exploring different treatment options with her physiotherapist to minimise the impact on her everyday life. Watch out for how she’s using Shared Decision Making techniques in another area of her life – an added bonus! 
Val lives a busy life with spina bifida, and was reluctant to spend time in bed when recovering from a serious deep tissue injury. A health professional involved in her care describes their discussions and compromises that led to shared decisions about the best treatment plan for Val. 


Training, Documents and Resources: