Rationale and impact
These sections briefly explain why the committee made the recommendations and how they might affect practice.
There was strong evidence to support using patient decision aids before, during and between discussions. However, the committee wanted to make it clear that decision aids alone do not deliver shared decision making but should be seen as 1 component of a wider approach. There would never be a patient decision aid available to support every discussion, and healthcare professionals still need to have the skills described in this guideline to engage people in making shared decisions irrespective of whether decision aids are available.
The committee agreed that for patient decision aids to be most useful, staff should have access to quality‑assured patient decision aids either via a maintained database or signposting to those produced by national bodies. They also highlighted that even though the evidence favoured using patient decision aids, it is crucial to provide them to people in formats they can use and understand otherwise they would not be useful. In the committee's view, organisations should think about ways to make sure that a database of quality‑assured decision aids is available to their staff in many different formats and that systems support using them in different ways. In the committee's experience, accessing decision aids in suitable formats is not always possible – for example, facilities to print out decision aids are not always available in consulting rooms across organisations, and some decision aids cannot be printed because of their format, for example, if they have a block colour background that requires a lot of ink.
The committee agreed that there were many good-quality patient decision aids that healthcare professionals could use and that more were being developed all the time. Many of them are freely available. Maintaining a database of decision aids could have a moderate resource impact, but the committee noted that these could be set up in collaboration with other organisations to maximise 'economies of scale'. The committee also noted that there might be some resource impact of printing more material for people.
The committee updated recommendations on communicating risks and benefits from NICE's guideline on patient experience in adult NHS services and brought them into this guideline.
The committee agreed that people's interpretation of risks, benefits and consequences is fundamentally embedded in their values and priorities, which explains why people do not weigh risks, benefits and consequences in the same way as others, or indeed in the same way as professionals.
The committee agreed that a person can only make an informed decision if they are given enough information to do so, and if the risks, benefits and consequences presented to them relate directly to their circumstances and what is important to them. Information about risks and benefits will be weighed differently in different situations and depending on a person's prognosis and the decisions they have to make. They discussed the evidence about presenting absolute risks compared with relative risks and noted that absolute risks are much clearer, especially when accompanied by visual summaries. They agreed that presenting relative risks alone was misleading and that relative risk should only be introduced as a supplement to absolute risks.
The committee wanted risks and benefits to be personalised using high-quality numerical data when these are available. Ideally, healthcare professionals would be able to provide personalised risk calculations. However, the committee acknowledged that personalised risk information is often not available. This means healthcare professionals often need to use generalised information about risks, benefits and consequences (usually available in good-quality decision aids) and explain to the person how it relates to them (for example, above average, average or below average levels of risk). Explaining how much uncertainty surrounds these estimates will help people interpret that information and what it means for them. The committee highlighted guidance from the General Medical Council (GMC) for more information – although GMC guidance is written for doctors, they agreed it provided an example of good practice for all professionals.
These recommendations will help healthcare professionals explore risk, benefits and consequences of healthcare decisions with people. The committee noted that because the recommendations in NICE's guideline on patient experience in adult NHS services have been in place since 2012, there should be no resource impact.