Choosing Wisely UK

Choosing Wisely

• Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses to make better decisions about care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit.
• It is hosted at the Academy of Medical Royal Colleges as part of their evidence based interventions programme.
• Includes 
• Shared decision making resources
• Recommendations for clinicians
• Patients Health A/Z

Shared decision making: shared reality or insider jargon?

Shared decision making: shared reality or insider jargon?
The Patients Association July 2021

• This report explores progress to date in shared decision making, and the extent to which it is a reality for patients. It identifies barriers to the adoption of shared decision making, and points the way towards -ways that might remove them in the future.

Shared Decision Making [NG197]

Shared decision making
NICE [NG197] 17 June 2021

• This guideline covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and people using services to work together to make decisions about treatment and care. It includes recommendations on training, communicating risks, benefits and consequences, using decision aids, and how to embed shared decision making in organisational culture and practices.

See also:

Standards framework for shared-decision-making support tools, including patient decision aids
NICE [ECD8] 17 June 2021

• This framework sets out a series of standards to support people using patient decision aids (PDAs) in assessing the usefulness and quality of a PDA.

Promise and perils of patient decision aids for reducing low-value care

Promise and perils of patient decision aids for reducing low-value care
BMJ Quality & Safety : 24 December 2020. doi: 10.1136/bmjqs-2020-012312

• A discussion of patient decision aids which aim to reduce the use of care considered of low value

The evidence base of interventions to improve planned care.

The evidence base of interventions to improve planned care.
NHS Midlands Decision Support Centre (DSC) November 2019

Transforming Outpatients (230pp), November 2019

• A directory of interventions, covering eight main interventions for transforming outpatient appointments, including: One-stop clinics; community-based clinics; alternatives to consultant-led care; virtual consultations; and, virtual follow-up clinics.

Self-Management November 2019

• A directory of interventions exploring the following themes: self-management; and, shared decision-making.

Rethinking Referrals November 2019

• A directory of interventions, and explores the following themes: advice and guidance; triage and clinical review; standard referral pathways and structured templates; and, shared learning opportunities.

Problem with patient decision aids

Problem with patient decision aids
BMJ Evidence-Based Medicine 21 May 2020. doi: 10.1136/bmjebm-2020-111371

• An exploration of the issues around guidelines and low certainty evidence to support patient decision aids.

Abstract

Choose Wisely UK

Choosing Wisely UK

• Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses. It is encouraging patients to have informed discussions with their clinicians and shared decision making.

RCGP Person-Centred Care Toolkit

Person-Centred Care Toolkit
RCGP ongoing

• The Person-Centred Care Toolkit has been developed with NHS England to support GPs and primary care teams deliver person-centred care. The person-centred care approach gives people more choice and control in their lives by providing an approach that is appropriate to the individual's needs. 
• Includes The conversations, social prescribing, health literacy, shared decision making, health coaching, personal health budgets, the consultation. Also a short evidence listing to support PCP.

Shared Decision Making: Summary Guide

Shared Decision Making: Summary Guide
NHS England 31 January 2019

• The Shared Decision Making Summary Guide is intended for people leading local implementation of shared decision making. 
• It enables:
• increased understanding of what good shared decision making looks like and how it ensures that we commission and provide systems and services that informed individuals want
• commissioning of local shared decision making initiatives and embedding them in care pathways
• providers to have better conversations with people using services, thereby supporting them to make more informed choices based on their personal values and preferences and what is known of the risks, benefits and consequences of the options available to them.

Universal Personalised Care: Implementing the Comprehensive Model

Universal Personalised Care: Implementing the Comprehensive Model
NHS England 31 January 2019

• This document sets out how the NHS Long Term Plan commitments for personalised care will be delivered. It establishes the Comprehensive Model for Personalised Care, comprising six, evidence-based standard components, and the detailed 21 actions to achieve its systematic implementation, right across the country. Implementation will be guided by delivery partnerships with local government, the voluntary and community sector and people with lived experience.
• The components are:

1. Shared decision making
2. Personalised care and support planning
3. Enabling choice, including legal rights to choice
4. Social prescribing and community-based support
5. Supported self-management
6. Personal health budgets and integrated personal budgets

Making place-based, person-centred health and care a reality

Shifting the centre of gravity: Making place-based, person-centred health and care a reality LGA 14 November 2018

• The examples in this report show what can be achieved by system leaders and staff from local government, the NHS, the voluntary, community and social enterprise sector, and service user and carer groups working together to improve health and deliver person-centred care. The review’s key findings revolve around shared outcomes, shared leadership and accountability and shared systems.
• Refresh of Stepping up to the place - a "shared vision for transforming health, care and wellbeing and the key actions that national and local organisations should take to successfully integrate health and care."

SHERPA: a new model for clinical decision making in patients with multimorbidity

SHERPA: a new model for clinical decision making in patients with multimorbidity
Lancet 20 October 2018 https://doi.org/10.1016/S0140-6736(18)31371-0

• Description of the Sharing Evidence Routine for a Person-Centred Plan for Action (SHERPA) framework, to facilitate conversations between health-care professionals and patients that lead to person-centred, evidence-informed, interpretative, collaborative decision making for all patients, especially those with multimorbidity.
• Development funded by National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC).

Interventions for increasing the use of shared decision making by healthcare professionals

Interventions for increasing the use of shared decision making by healthcare professionals
Cochrane Systematic Review 19 July 2018

• Analysis of 87 research articles concludes that while a great variety of activities exist to increase shared decision making by healthcare professionals, there is no confidence around which of these activities work best because the certainty (or the confidence) of the evidence has been assessed as very low.

Mechanisms and tools for use of health information for decision-making

Evidence on mechanisms and tools for use of health information for decision-making
WHO 2017

• An examination of the tools and mechanisms that can help to increase the use of health information in policy development. 
• It discusses
• packaging tools, including synthesis and visualization tools;
• application tools, including modelling and simulation;
• dissemination and communication tools such as electronic, automated and person-to-person dissemination methods; and
• linkage and exchange tools, including knowledge platforms and brokering.
• "The most effective use of health information is when all stakeholders interact and communicate to ensure the best available evidence is used to support choice of policy options."

How can we all best use scientific evidence?

How can we all best use scientific evidence?
Academy of Medical Sciences June 2017

• A survey of British adults which indicated that only 37% of the public said they trusted evidence from medical research, compared to 65% who trusted the experiences of their friends and family. 
• The Academy of Medical Science has drawn up an action plan on how to make sure medical research is robust, relevant, trusted and that the evidence generated is useful and accessible to doctors and patients.

Demand Management: Good Practice Guide for CCGs

Demand Management: Good Practice Guide
NHS England August 2016

• A list of initiatives and actions that CCGs should consider implementing locally, in collaboration with providers and other organisations, to effectively manage the increasing demand for elective care services (particularly to reduce unnecessary outpatient appointments).
• The guide is supplemented by case studies 
• Includes a  breakdown of growth in referrals by CCG (12 months to May 16) to benchmark changes
• Summary of actions and initiatives: 
• Peer Review of Referrals 
• Shared Decision Making 
• Choice 
• Advice and Guidance 
• Alternatives to Outpatient Appointments 
• Consultant-to-Consultant Referral Protocols 
• Direct Access to Diagnostics
• Management and Monitoring of Outpatient 
• Followup Appointments

Co-production Model

A Co-production Model
Coalition for Collaborative Care July 2016

• A simple guide to ensuring that the voices of people with lived experience are included in decision-making, from commissioning to co-design and co-delivery.
• The model sets out five values and seven behaviours which support development of a culture of co-production.
• "Co-production is a way of working that involves people who use health and care services, carers and communities in equal partnership; and which engages groups of people at the earliest stages of service design, development and evaluation. Co-production acknowledges that people with ‘lived experience’ of a particular condition are often best placed to advise on what support and services will make a positive difference to their lives. Done well, co-production helps to ground discussions in reality, and to maintain a person-centred perspective."
• "Co-production is part of a range of approaches that includes citizen involvement, participation, engagement and consultation. It is a cornerstone of self-care, of person-centred care and of health-coaching approaches."

Smarter engagement: Harnessing public voice in policy challenges

Smarter engagement: Harnessing public voice in policy challenges
Institute for Government, PWC 16 December 2015

• A discussion of the four drivers for change which make it vital to involve citizens in decisions:
• reductions – the Spending Review, increased pressure on the NHS and cuts to welfare will require citizens to adapt to leaner or reconfigured services
• infrastructure – much of the UK’s existing infrastructure must be replaced or replenished, but citizens must be convinced of the need for local disruption
• digital – the process of digitisation requires citizens to adapt to new ways of accessing services
• innovation – the way that services are designed and delivered is changing, moving to greater collaboration with citizens.
• The report presents five examples of better engagement from across the public sector and early insights about what works.

The patients voice is still weak

People in control of their own health and care: the state of involvement
Kings Fund, 4 November 2014

• This report examines the reasons why patients do not have a stronger voice in decisions about their health and care, and that services do not properly reflect their needs and preferences despite existing policies supporting this. It also considers how we can advance the cause of making person-centred care the core of health and care reform.
• The authors set out eight key forms of individual involvement, 
• engaging people in keeping healthy
• shared decision-making
• supported self-management
• having a personal health or social care budget
• involving families and carers
• choosing a provider
• taking part in research as part of your care and treatment 
• evaluating services through feedback
• Policy implications - In addition to work by NHS England on transforming participation,national bodies need to:
• develop a model of professional education and training based on working with users and citizens
• provide staff and patients with access to high-quality tools for structuring and recording care-planning and shared decision-making
• measure involvement and hold organisations to account
• enable local organisations to focus on patients not politicians, with a national approach to reform that supports organisations to lead change locally.

The link between staff engagement and quality of care

Improving NHS care by engaging staff and devolving decision-making
Kings Fund, 15 July 2014

• This review of staff engagement and empowerment in the NHS was commissioned by the Minister for Care and Support, Norman Lamb MP
• It found compelling evidence that NHS organisations with high levels of staff engagement – where staff are strongly committed to their work and involved in decision-making – deliver better quality care. These organisations report: 
• lower mortality rates 
• better patient experience
• lower rates of sickness absence and staff turnover.