Implementing shared decision making in the NHS: lessons from the MAGIC programme

Abstract

Shared decision making requires a shift in attitudes at all levels but can become part of routine practice with the right support, say Natalie Joseph-Williams and colleagues

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

“…The process evaluation, however, revealed additional “hidden” attitudes among staff that may contribute knowledge regarding the challenge of implementing recovery-oriented services such as SDM. Staff, who were very vocal in supporting user participation, nonetheless expressed concerns during the role play, that exposing users to various alternatives might lead to unnecessary stress, and would therefore instead decide which alternatives were most appropriate “for them.” This result, which was elicited in the concrete application of the DST, further supports the idea there is a complex interaction between attitudes and practice that demands further exploration (Joseph-Williams et al, 2017; Slade, 2017). …”

“…Others experienced this aspect of the training as too basic, suggesting that user involvement in decision-making and planning was an already integrated part of their practice. One barrier for implementation was therefore what might be referred to as the “we-already-do-that-syndrome,” a somewhat common experience in implementing recovery-oriented interventions (Joseph-Williams et al, 2017). Rather than exploring specific attitudes, assumptions and practice implications, the intervention is dismissed with this reasoning, prior to its implementation.…”

Improving communication about cancer screening: moving towards informed decision making

“…17 Furthermore, despite considerable research evidence supporting decision aids 11 , integrating shared decision making into routine clinical practice continues to be a challenge. 19 Alternatives include the 'consider an offer' approach, which aims to avoid overburdening people with unwanted information and tasks while respecting their autonomy 8 , and has been the basis for the approach to cancer screening communication in England since 2013. 17 The model involves helping people evaluate the trustworthiness and personal relevance of the screening offer, acknowledging that it might reasonably be declined, and making further information available for those who want it.…”

End of Life Care: How Do We Move Forward?

“…Turning these intentions from rhetoric to reality is a challenge, especially as clinicians feel increasingly under pressure. Joseph-Williams et al 23 describe a range of ways in which shared decision making can be implemented based on lessons learnt from the Making Good Decisions in Collaboration (MAGIC) programme, which had been commissioned by the Health Foundation to design, test and identify the best ways to embed shared decision making into routine primary and secondary care. The authors acknowledge the often claimed view that different patients want different levels of involvement but remind us that these preferences must be elicited rather than being based on the clinician's assumptions about the patient's desired level of involvement.…”