MAGIC CONCLUSION

Why Shared Decision Making isn’t enough

Andrew Rix

Styles within Evidence Based Medicinethe patient experience

• Directed – passive patient

• Shared – participating patient

• Facilitative – responsible patient

Styles within Evidence Based Medicinethe patient experience

• Directed – passive patient

• Expected tosubmit to tests without understanding themaccept treatment because that’s what’s on offerfulfil system requirements, targets and outcomesbe a case or record, not a personbe treated episodically

Patient centred care tools

style of medicine: directive

Doctor and system

decisions

Pathways and guidance

as Rules

patient role: passive

System management

Controlled information

delivery mode: reactive

Focus on records/clinical outcomes

Cumulative/episodic

Styles within Evidence Based Medicinethe patient experience

• Shared – participating patient expects tounderstand testsunderstand treatment optionsunderstand risks and benefitsunderstand the likelihood of occurrencehave fears and preferences taken into accounthave an opportunity to discuss and consider optionsbe part of any decisions ‘about me’be a person first, a case secondbe able to exercise choice

Patient centred care tools

style of medicine: shared

Doctor and patient

decisions

Pathways and

guidance

as boundaries

patient role: participative

SDM

Decision aids

delivery mode: informed

Focus on consultation and satisfaction

Episodic/incremental

Changes neededpassive to participative

Doctor • New skills & Tools

Patient• Activation to access evidence & empowerment

to question

System• Flexibility & Provision of Choice of treatment

SDM Benefits (and costs)

• Benefits

– Adherence

– Less expensive options

- Greater satisfaction

Costs

- reconfiguration

- new demands

- new behaviours

Styles within Evidence Based Medicinethe patient experience

Facilitative – responsible patient expectseverything above andthe support to manage their own healtha service that reflect their needsa say in the design of the servicea dynamic interaction via a planclear division and sharing of responsibilitiestreatment of the person not just the conditioncontinuity across time and conditions

Patient centred care tools

style of medicine: facilitated

Patient choice decisions

facilitated by doctor

Pathways and guidance as a starting point

patient role: responsible

Self –management

support

Motivational interviewing

Shared decision making

Structured patient education

delivery mode: planned

Focus on shared patient plan

dynamic

Changes neededparticipatory to responsible

Doctor

• New attitudes, values & skills

Patient

• Taking ownership & control

System

• Support for patients in their choice of service and care – co-creation

Facilitated medicine benefits (and costs)

• Benefits– Prevention

– LTC management

– Demand management

Costs

Reconfiguration

New demands

New behaviours

What produces the most significant change?

• Training clinicians in skills to engage with patients as partners

• A clear strategic message of support for patient centred care

• Listening to patients about their experience as the basis for change

• Some tools for clinicians and patients to support the new process

Will it happen?

• Drivers for change

– Information technology

– Clinical technology

– Cost constraints in current system

– The Francis watershed

• So the opportunity is there!