Quality statement 6: Decision making

Quality statement

People using adult NHS services are supported in shared decision making. [2012, updated 2019]

Rationale

People should have overall responsibility for managing their health. This needs to be recognised when providing services, and in the ways healthcare professionals interact with them. Health and social care professionals and services need to recognise that many people want to be active in their own care, although not everyone wants an active role. People should be able to work with services to actively manage their health, rather than passively receive care from services. Both healthcare professionals and patients have a role and responsibility for contributing to the decision-making process. Healthcare professionals contribute information about diagnosis, cause of disease, prognosis, treatment options and outcomes. Whereas, patients contribute the experience of their illness, how they manage their illness, social circumstances, attitudes to risk, values and preferences.

Quality measures

Structure

a) Evidence of a system that supports the use of shared decision making such as appointment systems that allow decisions to be discussed, and patient record systems that can document shared decisions and patient preferences.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that healthcare professionals support people to understand their treatment options, including the benefits, risks and potential consequences of relevant treatments.

Data source: Local data collection.

c) Evidence of local arrangements to ensure that people are actively involved and supported in shared decision making.

Data source: Local data collection.

d) Evidence of local arrangements to ensure that people are made aware of their right to choose, accept or decline treatment and that these decisions are respected and supported.

Data source: Local data collection.

e) Evidence of local arrangements to ensure that people are made aware that they can ask for a second opinion.

Data source: Local data collection.

Process

a) Proportion of people who reported that a member of staff answered their questions before their operation or procedure in a way they could understand.

Numerator – the number in the denominator who reported that, before their operation or procedure, a member of staff answered their questions about it in a way they could understand 'completely'.

Denominator – the number of people having an operation or procedure as an inpatient in hospital.

Data source: Care Quality Commission (CQC) Adult inpatient survey.

b) Proportion of people staying in hospital who reported that they were involved as much as they wanted to be in decisions about their care and treatment in hospital.

Numerator – the number in the denominator who reported that they were 'definitely' involved as much as they wanted to be in decisions about their care and treatment.

Denominator – the number of people staying as an inpatient in hospital.

Data source: CQC Adult inpatient survey.

c) Proportion of people who reported that they were involved as much as they wanted to be in decisions about their discharge from hospital.

Numerator – the number in the denominator who reported that they felt they were involved as much as they wanted to be in decisions about their discharge from hospital.

Denominator – the number of people staying as an inpatient in hospital.

Data source: CQC Adult inpatient survey.

d) Proportion of people who were involved in decisions about their care and treatment as much as they wanted to be at their last GP appointment.

Numerator – the number in the denominator who were involved in decisions about their care and treatment as much as they wanted to be.

Denominator – the number of people reporting on their last GP appointment.

Data source: NHS England GP patient survey.

Outcome

a) Evidence from patient experience surveys and feedback that people feel able to make decisions that reflect what is important to them.

Data source: Local data collection from surveys.

b) Evidence from patient experience surveys and feedback that people know about their right to choose, accept or decline treatment and feel that their decisions were respected and supported.

Data source: Local data collection from surveys.

c) Evidence from patient experience surveys and feedback that people know that they can ask for a second opinion.

Data source: Local data collection from surveys.

What the quality statement means for different audiences

Service providers (such as GPs, hospitals, community services and local authorities) ensure that systems are in place to train and assess staff competency in relevant communication skills. They have systems to support people to understand relevant treatment options, actively involve them in shared decision making and support them to make fully informed choices about investigations, treatment and care. Providers make patients aware of their right to choose or decline treatment, or ask for a second opinion, and make sure that their staff respect these decisions.

Health and social care professionals (such as GPs, doctors, nurses and social workers) have training in relevant communication skills. They support people to understand treatment options and actively involve them in shared decision making to make fully informed choices about investigations, treatment and care. Professionals make people aware of their right to choose or decline treatment, or ask for a second opinion, and respect these decisions.

Commissioners (such as clinical commissioning groups and NHS England) commission services that have arrangements for competency-based training and assessment of relevant communication skills. They use service specifications to ensure that people are supported to understand relevant treatment options, are actively involved in shared decision making and supported to make fully informed choices about investigations, treatment and care. They commission services that make people aware of their right to choose or decline treatment, or ask for a second opinion, and these decisions are respected.

People using NHS services are cared for by staff who can talk to them in a clear and understandable way. They are helped by healthcare professionals to understand their treatment options and are actively involved in shared decision making to make fully informed choices about investigations, treatment and care. People have their choices respected when deciding to choose or decline treatment, or ask for a second opinion.

Source guidance

Patient experience in adult NHS services (2012) NICE guideline CG138, recommendations 1.1.2, 1.3.7, 1.3.8, 1.5.4, 1.5.10, 1.5.20 to 1.5.25, and 1.5.27

Definitions of terms used in this quality statement

Shared decision making

This is when health professionals and patients work together. It puts people at the centre of decisions about their own treatment and care. During shared decision making, it's important that:

  • care or treatment options are fully explored, along with their risks and benefits

  • different choices available to the patient are discussed

  • a decision is reached together with a health and social care professional.

[NICE's information on shared decision making]