KEYNOTE 2 – What people want from their medicines – Making shared decisions

Linked to EAHP Statements

Section 1 – Introductory Statements and Governance: Statement 1.1
Section 4 – Clinical Pharmacy Services: Statements 4.1, 4.6
Section 5 – Patient Safety and Quality Assurance: Statements 5.1, 5.5

ACPE UAN: 0475-0000-22-002-L04-P. A knowledge-based activity.

Abstract

Shared decision making (SDM) is a process in which healthcare professionals and patients work together to make decisions on treatments jointly. When successful, SDM should result in decisions about a patient’s care that are aligned with both the best available evidence and the patient’s informed preferences and values. To do this requires healthcare professionals to engage effectively with people to determine what really matters to them about their disease or illness at this point in time and what a good outcome would look like for them.

SDM is appropriate in any healthcare setting whenever there is more than one treatment or management option available, including doing nothing. Having excellent communication and consultation skills is essential for hospital pharmacists to engage in the most appropriate way with the patient, to learn about their preferences, communicate to them the evidence-based information available and jointly agree on the decisions made.

In 2014, the Health Foundation found that a large majority of patients in the UK general practice wanted to be involved in decisions about their care. Subsequent evidence suggest that this is the case throughout the developed world. This does not mean that patients have to make the final decision, but that they wish to be involved in the process. As Melnikow and Kravitz put it, “Most patients want to see the road map, including alternative routes, even if they don’t want to take over the wheel.” The Montgomery ruling in the UK in 2015 provides a basis in law for the promotion of SDM; put simply, clinicians should not make decisions for patients, but with patients instead.

Current research suggests that SDM does not occur to the extent that it should. The UK’s Clinical Quality Commission (CQC) annual inpatient survey features the question “Were you involved as much as you wanted to be in decisions about your care and treatment?” The latest data from 2020 shows that less than half of patients were not involved as much as they wanted to be. Further survey data highlights that SDM is required in both primary and secondary care.

This keynote will address the barriers to making SDM routine by outlining the evidence base showing the benefits of SDM, while sharing practical, pragmatic experience of an academic general practitioner from the UK who has made this a routine part of his work. A patient perspective will also be shared where real life examples and stories are used to demonstrate how SDM can help people cope better with their multimorbidity. Enabling hospital pharmacists to improve their knowledge and skills around evidence-informed decision making and consultation skills is essential if we are to achieve the aim of involving patients in their choices on which medicines to take. It will also enable them to take this back to their places of work to spread the message to others in their teams.

Learning objectives
After the keynote, participants should be able to:

• Describe the features of a patient-centred consultation
• Discuss the different approaches to making decisions with patients
• Describe the different techniques for exploring the values and preferences that a patient holds
• Appraise the different approaches to risk communication
• Recognise the affective and cognitive biases that could affect decision making

Educational need addressed
This keynote addresses the skills needed by hospital pharmacists to effectively cooperate with the patient in the shared decision making process.

Keywords: Clinical decision support, communication, evidence-based medicine, health literacy, polypharmacy.