Shared decision-making: summary of NICE guidance

Carmona, Chris; Crutwell, Joseph; Burnham, Marie; Polak, Louisa

doi:10.1136/bmj.n1430

Cited by 51 publications

(58 citation statements)

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“…The OPTION 5 instrument is ordinal by design, which implies that nonparametric statistical analyses are required. In most studies, however, OPTION 5 scores have been analysed as a continuous variable using parametric statistical techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Because it focuses on clinician behaviour, it appeared suitable for our research question. The OPTION 5 is the validated concise version of the OPTION instrument 15 and is considered to be more efficient with lower cognitive burden for raters than the original 12-item instrument 16 Following the OPTION 5 manual, each item was scored on a Likert-scale ranging from 0 (no effort) to 4 (exemplary effort). Following recommendation of the OPTION 5 scoring manual, these items were rescaled by a factor 5 (resulting in items scores ranging from 0 to 20, and total scores ranging from 0 to 100.…”

Section: Observed Patient Involvementmentioning

confidence: 99%

“…Following recommendation of the OPTION 5 scoring manual, these items were rescaled by a factor 5 (resulting in items scores ranging from 0 to 20, and total scores ranging from 0 to 100. 17 Two trained researchers (EMD, a medical doctor and RH, a linguistics master student) independently scored the first 29 videotaped encounters using the OPTION 5 . Then they compared and discussed scoring differences until consensus was reached.…”

Section: Observed Patient Involvementmentioning

confidence: 99%

“…In Western societies, shared decision making (SDM) is increasingly championed by patients, clinician organisations and policy-makers as the preferred model for making patientcentred healthcare decisions [1][2][3][4][5] and achieving value based healthcare. 6 The implementation of SDM in clinical practice, however, remains suboptimal.…”

Section: Introductionmentioning

confidence: 99%

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Do consultants do what they say they do? Observational study of the extent to which clinicians involve their patients in the decision-making process

2022

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ObjectivesTo assess whether consultants do what they say they do in reaching decisions with their patients.DesignCross-sectional analysis of hospital outpatient encounters, comparing consultants’ self-reported usual decision-making style to their actual observed decision-making behaviour in video-recorded encounters.SettingLarge secondary care teaching hospital in the Netherlands.Participants41 consultants from 18 disciplines and 781 patients.Primary and secondary outcome measureWith the Control Preference Scale, the self-reported usual decision-making style was assessed (paternalistic, informative or shared decision making). Two independent raters assessed decision-making behaviour for each decision using the Observing Patient Involvement (OPTION)5 instrument ranging from 0 (no shared decision making (SDM)) to 100 (optimal SDM).ResultsConsultants reported their usual decision-making style as informative (n=11), shared (n=16) and paternalistic (n=14). Overall, patient involvement was low, with mean (SD) OPTION5 scores of 16.8 (17.1). In an unadjusted multilevel analysis, the reported usual decision-making style was not related to the OPTION5 score (p>0.156). After adjusting for patient, consultant and consultation characteristics, higher OPTION5 scores were only significantly related to the category of decisions (treatment vs the other categories) and to longer consultation duration (p<0.001).ConclusionsThe limited patient involvement that we observed was not associated with the consultants’ self-reported usual decision-making style. Consultants appear to be unconsciously incompetent in shared decision making. This can hinder the transfer of this crucial communication skill to students and junior doctors.

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Section: Discussionmentioning

confidence: 99%

Section: Observed Patient Involvementmentioning

confidence: 99%

Section: Observed Patient Involvementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Do consultants do what they say they do? Observational study of the extent to which clinicians involve their patients in the decision-making process

2022

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“…Shared decision making (SDM) consists of communication, collaboration, aspects of evidence based medicine, and relationship building—all based on the principle of the autonomy of the patient. It is a complex process with each consultation unique 1. SDM, therefore, remains an ideal.…”

mentioning

confidence: 99%