Shared decision making is a collaborative process that involves a person and their healthcare professional working together to reach a joint decision about care. It could be care the person needs straightaway or care in the future, for example, through advance care planning. See the full definition of shared decision making.
For more information on what shared decision making means for people receiving care and treatment, see making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
1.3.1 Use patient decision aids as one part of an overall 'toolkit' to support shared decision making alongside the other skills and interventions outlined in section 1.2 and section 1.4 of this guideline. If a relevant decision aid is not available, continue to use the shared decision-making principles outlined in this guideline.
1.3.2 Only use a patient decision aid if it is:
quality assured and reflects evidence-based best practice
relevant to that discussion and the decision that needs to be made
relevant to that clinical setting.
1.3.3 Before using a particular decision aid, healthcare professionals should make sure they are familiar with it, including how it will help people to understand which option is best for them.
Also see recommendations 1.6.10 to 1.6.12 in NICE's guideline on medicines optimisation on making patient decision aids available for consultations about medicines.
1.3.4 Think about ways to give staff in the organisation or system access to quality-assured patient decision aids (assessed against NICE's standards framework for shared decision making support tools, including patient decision aids, or the International Patient Decision Aid Standards). This could be by maintaining a database of decision aids that are regularly reviewed and updated, or signposting staff to decision aids produced by national bodies such as NICE.
1.3.5 Organisations should ensure their facilities and systems support staff to provide patient decision aids in multiple ways to suit people's needs, for example, printed or online and available in different languages and formats.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on patient decision aids.
Full details of the evidence and the committee's discussion are in evidence review C: decision aids for people facing health treatment or screening decisions.
1.4.1 Discuss risks, benefits and consequences in the context of each person's life and what matters to them. Be aware that risk communication can often be supported by using good-quality patient decision aids or graphical presentations such as pictographs (see recommendations 1.3.1 to 1.3.3).
1.4.2 Personalise information on risks, benefits and consequences as much as possible. Make it clear to people how the information you are providing applies to them personally and how much uncertainty is associated with it. For more on dealing with uncertainty, see the General Medical Council's guidance on decision making and consent.
1.4.3 Organisations should ensure that staff presenting information about risks, benefits and consequences to people have a good understanding of that information and how to apply and explain it clearly (see recommendations 1.1.12 and 1.1.13).
1.4.4 If information on risks, benefits and consequences specific to the person is not available, continue to use the shared decision making principles outlined in this guideline.
1.4.5 Think about using a mixture of numbers and pictures, for example, numerical rates along with pictograms or icon arrays, to allow people to see both positive and negative framing (see recommendation 1.4.11) at the same time.
1.4.6 Use numerical data to describe risks if available. Be aware that different people interpret terms such as 'risk', 'rare', 'unusual' and 'common' in different ways.
1.4.8 Use natural frequencies (for example, 10 in 100) rather than percentages (10%).
1.4.9 Be consistent when using data. For example, use the same denominator when comparing risk: 7 in 100 for one risk and 20 in 100 for another, rather than 1 in 14 and 1 in 5.
1.4.10 Present a risk over a defined period of time (months or years) if relevant. For example, if 100 people have treatment for 1 year, 10 will experience a given side effect.
1.4.11 Use both positive and negative framing. For example, treatment will be successful for 97 out of 100 people and it will be unsuccessful for 3 out of 100 people.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on communicating risks, benefits and consequences.
Full details of the evidence and the committee's discussion are in evidence review D: risk communication.
A technique to break down information into smaller, more manageable chunks rather than providing it all at once. In between each 'chunk', methods such as teach back are used to check for understanding before moving on.
In this guideline, a discussion is any interaction (in person or remote) between a healthcare professional and a person using services in which a healthcare decision might be made.
For the purpose of this guideline, this could refer to any organisation or network of organisations, for example, a general practice, a single hospital or clinic, a network or cluster of clinics, practices or services, or an integrated system or partnership between services, for example, a local dental network.
Patient decision aids are tools designed to help people take part in decision making about healthcare options. They provide information on the options and help people to think about, clarify and communicate the value of each option to them personally.
Patient decision aids do not advise people to choose 1 option over another, nor are they meant to replace healthcare professional consultation. Instead, they support people to make informed, values-based decisions with their healthcare professional.
(Adapted from the International Patient Decision Aid Standards Collaboration website.)
The teach back method is a useful way to confirm that the information provided is being understood by getting people to 'teach back' what has been discussed and what instruction has been given. This is more than saying 'do you understand?' and is a check of how well things have been explained and understood.
The three-talk model is a practical model of how to do shared decision making that is based on following choice, option and decision talk stages during the consultation. The model has 3 steps:
describing options, often by integrating the use of patient decision support
helping people explore their preferences and make decisions.