Shared decision making in realistic medicine: what works

1. Introduction

Realistic Medicine puts the person receiving care at the centre of decision making and creates a personalised approach. Changing our style to shared decisions and enabling people to make informed choices about their care, based on what matters most to them, are priorities for Realistic Medicine. This report provides a synthesis of the evidence on shared decision making (SDM):

• Section 1 outlines the methodological approach and evidence base;
• Section 2 defines SDM and what is currently known about SDM in Scotland;
• Section 3 highlights the barriers to further uptake;
• Section 4 highlights practical tools, skills, attitudes and conditions to encourage greater SDM in clinical consultations; and,
• Section 5 provides some conclusions and recommended next steps.

1.1 Aims

This report synthesises evidence on SDM applicable to Scotland from the last 5-10 years with the aim of highlighting some practical tools, skills and behaviours that can encourage greater engagement in SDM. The objectives of the review were to identify:

• What we know about shared decision making in Scotland
• What are the existing barriers to further uptake of SDM in clinical consultations?
• What can be done to encourage greater engagement of SDM in clinical consultations in Scotland?

1.2 Methodology and search strategy

Literature searches were conducted using a range of databases and search terms. Although the primary interest was in evidence from Scotland, a wider geographic search was carried out to capture other relevant evidence. Larger scale systematic reviews and meta-analyses on SDM were the focus, rather than smaller scale single condition studies, however some smaller scale studies were included when they specifically concerned the views of patients, clinicians, or the barriers and facilitators of SDM, or if they were of particular relevance to Scotland. Specifically 76 journal articles and policy reports were used as evidence within this report, along with supporting material from several relevant websites. More details on the search strategy and evidence base and gaps can be found in Annexes 1 and 2.

Overall, the review of the evidence identified a lack of studies on evaluating the impacts of SDM, and on the wider impacts of SDM (i.e. over and above the patient-clinician relationship), and difficulties in envisioning what an SDM process could look like in practice. As such, suggestions for further research are:

• Conduct further research into how best to measure the impact of SDM (in terms of: patient and clinician satisfaction; and reducing waste and variation);
• Raise awareness of the SDM process (in practice) and its benefits to patients, clinicians and national-level stakeholders;
• Gain a better understanding of the role of issues such as trust and power within SDM encounters.