Shared Decision Making Standard

Shared decision making is a collaborative process where clinicians and individuals consider treatment options based on evidence about their potential benefits and harms, to enable the person to decide the best course for themselves. The conversation and decision made should be informed by what matters to the person, their goals, values, hopes, ideas, concerns and expectations.

When people are listened to, given the information they need and the time and support to make informed decisions about their care and treatment, they have the potential for better outcomes and experiences of care.

Current release

Version: V0.6
Release date
June 2022
Next release date
TBA
Next release type
Scheduled release
The standard
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Minimum Viable Information Standard (MVIS)
MVIS sets out the data items and business rules that must be implemented to achieve safe, minimum implementation . Read more >
Supporting documentation
Description/purpose
Implementation guidance
This document includes general implementation guidance for all PRSB standards. Detailed implementation guidance specific to the sections and elements of this standard are included within the information model.
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Rules for implementation of the standard.
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Describes the purpose, methodolgy and stakeholder engagement for developing the standard, along with the findings and recommendations for further work.
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Summarises the hazards which could result from implementing the standard.
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Details the potential hazards from implementing the standard with their risk rating and mitigation.
Provenance data
Defines the information on who made a record entry and who carried out the activity, where and when.
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About this standard

The PRSB information standard on shared decision making provides a framework for clinicians to record the decision-making process between themselves and their patients. The standard also allows the shared decision information to be shared between professionals and their different record systems. The standard has been developed based on the GMC guidance on shared decision-making and consent and the NICE guidelines. 

Scope

  • The standard was developed with UK wide consultation and engagement to meet the needs of all four UK nations.
  • The standard is intended for all areas of healthcare except for the noted exclusions
  • The standard covers all ages¬†including children

 

The following 8 different scenarios were used to help develop and test the standard;

  • Elective surgery
  • Multiple long-term conditions‚ÄĮ¬†
  • Mental Health¬†
  • Genetic conditions
  • Polypharmacy¬†¬†
  • Orthopaedics¬†
  • Gynaecology
  • Children and dentistry

Not in scope:

  • ¬†Maternity ‚Äď The standard may work for maternity, but it is believed that this complex area justifies specific additional work and potentially an extended standard.
  • Social Care ‚Äď The Shared Decision Making Standard is defined for clinical uses and the consultation was targeted at healthcare professionals not social care professionals. However the standard’s principles may work in social care and in the future the standard could potentially be adapted for use in social care.

How it works

The standard sets out the information that should be recorded for a shared decision making discussion between a clinician and patient, and then shared afterwards with the patient and other professionals who care for them. 

Here is an excerpt from a summary view of the standard that shows main sections and elements.  It gives a description of the information to be captured and also tells the clinician what information is Mandatory (M Рmust be recorded), Required (R Рshould be recorded if the information exists), and what is Optional (O Рlocal decision if its recorded) in the Conformance column. 

Section and element name
Conformance
Description
Problem list
M
A summary of the problems that require investigation or treatment.
Problem
M
The problem that the shared decision is addressing
Shared decision point
M
This is a shared decision point record entry. There may be 0 to many record entries under a section. Each record entry is made up of a number of elements or data items.
Shared decision status
M
The current status of the decision (In progress, Valid, Cancelled).
Pre-discussion information shared
R
A record of the actions taken to prepare the patient to make a shared decision before the encounter where a shared decision was made. This should include a summary of any resources the person was offered to prepare them for the decision making process.

This is an excerpt taken from a high-level summary view of the standard. 

 

Here we can see an example of a shared decision making journey from starting a shared decision with a patient and their clinician, through to planning and discussion and then making a final agreement to document in a patient’s care record. This journey will often be over multiple appointments and could be with different clinicians.¬† The standard is designed for this and also to allow for pauses in the process for consideration and reflection and for changes of the decision.¬†

Starting a shared decision

The first meeting
Joe meets or talks on the phone with his clinician (this is his doctor or nurse or other health professional) who has diagnosed the problem.
The clinician explains the diagnosis to Joe and says there are choices for his treatment or support.
The clinician gives Joe some information on the choices available to consider before further meetings.
The clinician asks if Joe would want someone to be at the next meeting.

Shared decision discussions

Talking through the choices
Joe meets the clinician to discuss the best treatment or support for him. This is the shared decision making discussion.
Joe consents to the meeting being recorded so it can be referred to later.
The clinician checks with Joe to agree that this is the expectation for the meeting so that he understands his diagnosis.
The clinician and Joe explore what’s important to Joe, his concerns, expectations, needs and goals.
The clinician explains each of the options along with their risks and benefits for Joe.
They discuss and reach a shared decision on the best option for Joe. Joe decides he needs more time to consider. The doctor sends Joe a letter with the details of the discussion.

Reaching a final decision

Agreeing what is important
They recap and discuss as needed, considering what’s important to Joe, the options and their risks and benefits.
They record the option agreed and a review date. If needed they can record any issues Joe had with the decision or any comments made by the clinician.
If required, Joe provides consent for the chosen treatment or support. Details about the consent form are recorded.
The clinician notes the actions for Joe and themselves (such as to start the chosen treatment or support option).

Examples

To give a clearer idea of how the standard works in practice we have created some examples to help make it clearer what information is recorded in different SDM scenarios, and how this works across multiple appointments. 

These examples are based on role plays with practising clinicians and either patients or actors. In some cases they are shown with two views, one for clinicians and people and another for system suppliers using the full information model.

person in consultation

Further resources

  • Minimum viability information standard (MVIS)
    PRSB information standards define best practice based on evidence and widescale consultation and input from users and stakeholders. PRSB recognises that the NHS and social care are on a journey towards standardisation and interoperability and our aim is to support and encourage implementers on that journey. For this reason, we have defined and clinically validated a ‘Minimum Viable Information Standard (MVIS)’ for each of our standards which represent the minimum safe instance of the standard and delivers the intended objectives within the spirit of the standard. The MVIS defines the data items and business rules which must be implemented in order to have achieved this minimum instance. It is our aim that implementers will continue to improve their implementation of the standard over time and strive for a ‘best practice’ implementation, supported and evidenced by PRSB conformance testing. Please contact our support team to receive a copy of the MVIS for this standard.
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  • Standards explained
    PRSB’s guide to standards which sets out the purpose and benefits of using standards and how to support frontline professionals to adopt them.
  • IHRIM record correction guidance
    Despite vigilance when filing information in records, mistakes can occur. The Institute of Health Records and Information Management has guidance to support professionals in making corrections following errors.
  • Transfers of care discovery report
    The eDischarge Summary Standard was first published in 2015. Despite significant investment in programme initiatives, the widespread implementation of the standards has been slow.
    In this report we identify the challenges that have inhibited the adoption of the standard, make recommendations for improvements and set out the anticipated benefits that this will bring.

Endorsement

Endorsement is in progress for the draft standard and details will be published here when this work is complete.

This standard is dedicated to the memory of Mr James Brown, clinical lead on the standard development.