Reaching a shared understanding of shared decision making in health care: NICE's experience of scoping the shared decision making guideline

Abstract

NICE's guideline on shared decision making, currently under development, endeavours to support shared decision making as part of routine health care practice. In this article, we summarize our learning to date, gained through the scoping of the guideline, on the key challenges that need to be addressed in the guideline. The production of a scope is the first stage in the development of a NICE guideline, setting the parameters for what will be considered in the guideline. The process for scoping the shared decision making guideline involved discussion with early recruited committee members and engagement with registered stakeholders, through both a workshop and formal consultation. Important, and sometimes divergent, viewpoints about shared decision making were revealed through this process. The key challenges centred on the issues of a need for a common definition of shared decision making, measurability, opportunities, barriers to implementation, and feasibility. Recognizing these challenges aided the refinement of the scope in terms of what the guideline will cover, draft questions and main outcomes for consideration.

Interactions between persons—Knowledge, decision making, and the co‐production of practice

“…Discussions involving regulators, patients and practitioners attempted to identify patient and practitioner values, testing their application by using methods including case studies and considering barriers with reference to real patient narratives. The efforts to improve communication and mutual understanding include improving connections between different professionals, in an area where “practitioners work largely in sole‐practice and without employers or teams.” Like the work of Wohlgemuth et al, this is very much a work in progress, and the authors detail the future stages of the project in their progress report.…”

“…Following the conference address by Sir Andrew Dillon, chair of NICE, Clare Wohlgemuth and colleagues from NICE's Centre for Clinical Guidelines report on the organization's efforts to establish a “shared understanding of shared decision‐making in healthcare.” In their efforts to develop a guideline, NICE colleagues commence with a “scoping” process aimed at discovering the key challenges the guideline will need to address, thus “setting the parameters for what will be included in the guideline.” Discussions with a range of stakeholders revealed divergent viewpoints, presenting difficulties in finding a common definition of SDM and raising questions about “measurability, opportunities and barriers to implementation as well as feasibility.” The report provides an interesting insight into how guideline developers go about attempting to respond to such challenges, in the case of a guideline that is still very much a work in progress.…”

“…It includes papers on the nature of reasoning and evidence, the on‐going problems of how to “integrate” different forms of scientific knowledge with each other, and with broader, humanistic understandings of reasoning and judgement, patient and community perspectives . Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under‐developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on SDM, analysing its proper meaning, its role in policy, methods for realizing it and its limitations in real‐world contexts …”

Can electronic assessment tools improve the process of shared decision-making? A systematic review

“…The importance of shared decision-making to clinical practice is widely acknowledged (Corrigan, 2005;Lansley, 2010;Right Care, 2018;Wohlgemuth et al, 2019). Global research data show that there is large geographical variation in the number of surgical procedures carried out for the same conditions, particularly in the United States (Wennberg et al, 2007).…”

Clinical reasoning as midwifery: A Socratic model for shared decision making in person‐centred care

“…Shared decision making is a highly contested concept as our discussion below will show. Nonetheless, it is possible to say, in brief, with the National Institute for Health and Care Excellence, that shared decision making is ‘a collaborative process through which a health care professional supports a person to reach a decision about their care, now or in the future (Wohlgemuth et al, 2019)’. Exactly how that practitioner–patient collaboration ought to proceed is the topic of this paper.…”