Confidential: For Review Only Implementing shared decision making in routine NHS settings - lessons from the MAGIC Programme Journal: BMJ Manuscript ID BMJ.2016.033197 Article Type: Analysis BMJ Journal: BMJ Date Submitted by the Author: 26-Apr-2016 Complete List of Authors: JOSEPH-WILLIAMS, NATALIE; Cardiff University, College of Biomedical Life Sciences Lloyd, Amy; Cardiff University, College of Biomedical Life Sciences, Centre for Trials Research Edwards, Adrian; Cardiff University, College of Biomedical Life Sciences, Division of Population Medicine Stobbart, Lynne; Newcastle University, Institute of Health & Society Tomson, David; Collingwood Surgery Macphail, Sheila; The Newcastle Upon Tyne Hospitals NHS Foundation Trust Dodd, Carole; The Newcastle Upon Tyne Hospitals NHS Foundation Trust Brain, Katherine; Cardiff University, College of Biomedical Life Sciences, Division of Population Medicine Elwyn, Glyn; Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice Thomson, Richard; Newcastle University, Institute of Health & Society Keywords: Shared Decision Making, Patient centred care, Implementation, Patient involvement, Quality improvement, Patient participation, Physician-patient relations https://mc.manuscriptcentral.com/bmj BMJ
18
Embed
Confidential: For Review Only - bmj.com · Confidential: For Review Only ... BMJ Journal: BMJ Date Submitted by the Author: ... Adoption of shared decision making (SDM) ...
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Confidential: For Review O
nly
Implementing shared decision making in routine NHS
settings - lessons from the MAGIC Programme
Journal: BMJ
Manuscript ID BMJ.2016.033197
Article Type: Analysis
BMJ Journal: BMJ
Date Submitted by the Author: 26-Apr-2016
Complete List of Authors: JOSEPH-WILLIAMS, NATALIE; Cardiff University, College of Biomedical Life Sciences Lloyd, Amy; Cardiff University, College of Biomedical Life Sciences, Centre for Trials Research Edwards, Adrian; Cardiff University, College of Biomedical Life Sciences,
Division of Population Medicine Stobbart, Lynne; Newcastle University, Institute of Health & Society Tomson, David; Collingwood Surgery Macphail, Sheila; The Newcastle Upon Tyne Hospitals NHS Foundation Trust Dodd, Carole; The Newcastle Upon Tyne Hospitals NHS Foundation Trust Brain, Katherine; Cardiff University, College of Biomedical Life Sciences, Division of Population Medicine Elwyn, Glyn; Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice Thomson, Richard; Newcastle University, Institute of Health & Society
Keywords:
Shared Decision Making, Patient centred care, Implementation, Patient
Walk-arounds (clinic visits) by Executive Board members
Internal Board reports identifying shared decision making as an
organisational priority
Grand Rounds presented by senior clinicians
Dedicated Executive Board member working with implementation team
“Board check list”
Framing interventions / approaches as healthcare organisations initiatives
(internally promoted).
Patients’ perceptions that the organisations and clinicians want
them to become more involved.
Structural
considerations
Supportive policy context i.e. making sure broader healthcare policies align
with the principle of SDM.
Encouragement and support from professional bodies of SDM approach.
Integration of patient-centred care / SDM into undergraduate medical /
nursing curriculum and continued inter-professional development.
Ensuring other systems / targets are compatible with SDM approach e.g.
Quality Outcomes Framework, criterion based systems of referral
management and guidance
Incentivisation at national, regional and organisational level.
Role of commissioning in England e.g. inclusion in CQUIN
Enabling clinicians and managers to see SDM as part of what
they already do – linking to other aspects of patient centred
practice.
Gradually moving SDM from ‘project’ to something that is part
of the organisation’s core function.
* A wide range of the MAGIC resources / interventions listed in this table can be found on The Health Foundation’s Person Centred Care Resource Centre:
http://personcentredcare.health.org.uk/ All materials are available open access.
This paper originated from the learning from the Making Good Decisions in Collaboration (MAGIC)
Programme, funded by The Health Foundation. NJW drafted the manuscript, and all authors worked collaboratively to contribute to the content, edit, and agree the final version. All authors were involved
in the MAGIC programme and contributed to the learning that is described throughout this manuscript.
NJW is a Research Fellow conducting patient centred care implementation research at the Division of
Population Medicine, Cardiff University. NJW was the Cardiff-based Programme Manager for MAGIC.
AL is a Research Fellow working on the design and implementation of interventions to improve clinical
practice. AL was the Cardiff-based SDM facilitator for MAGIC. AE is Professor of General Practice at
the Division of Population Medicine, Cardiff University, with research and teaching interests in
healthcare communication and quality improvement. LS is a Senior Research Associate and was the
Newcastle-based SDM facilitator for MAGIC. DT is a full time GP with long term interest in patient centred practice and training. He took a lead on the training programme in MAGIC. CD is an NHS
manager with broad experience in quality improvement implementation programmes. CD was the
Newcastle-based Programme Manager for MAGIC. SM was a Consultant Obstetrician and Fetal Medicine Specialist who facilitated the project with the Newcastle Upon Tynes Hospitals NHS
Foundation Trust, and took a lead in developing the training tools and delivering training to clinical
teams in secondary care. KB was PI in Cardiff for Phase 2 of MAGIC, and is a registered health psychologist with expertise in psychological aspects of cancer early diagnosis, prevention and
screening. GE was PI in Cardiff for Phase 1 of MAGIC and co-led the development of the programme.
GE oversaw implementation of SDM in Cardiff during Phase 1. RT was PI in Newcastle for Phases 1
and 2 of MAGIC, and co-led the development of the programme, and oversaw implementation in
Newcastle during Phases 1 and 2.
Competing Interests:
We have read and understood the BMJ Group policy on declaration of interests and declare that we have no competing interests.
Exclusive Licence:
The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all
authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats and
media (whether known now or created in the future), to i) publish, reproduce, distribute, display and
store the Contribution, ii) translate the Contribution into other languages, create adaptations, reprints,
include within collections and create summaries, extracts and/or, abstracts of the Contribution and
convert or allow conversion into any format including without limitation audio, iii) create any other
derivative work(s) based in whole or part on the on the Contribution, iv) to exploit all subsidiary rights
to exploit all subsidiary rights that currently exist or as may exist in the future in the Contribution, v) the
inclusion of electronic links from the Contribution to third party material where-ever it may be located;
Key Messages
• Skills trump tools, but attitudes trump skills - shared decision making is
about more than tools
• Preparation before enablement, in a supportive clinical team - successful implementation relies on a combination of interventions targeted at the
organisation, clinician, and patient level
• Organisational support and local ownership are vital for engagement
and, vi) licence any third party to do any or all of the above. All research articles will be made available
on an Open Access basis (with authors being asked to pay an open access fee). The terms of such Open
Access shall be governed by a Creative Commons licence—details as to which Creative Commons
licence will apply to the research article are set out in our worldwide licence referred to above.
Acknowledgements:
This paper originated from the MAGIC programme, funded by The Health Foundation. This programme involved collaboration between the following organisations: Cardiff and Vale University Health Board,
Cardiff University, the Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle
University. We are grateful to all of the MAGIC contributors, including the organisational
representatives, clinical teams, and patients for their contribution to the learning.
1. The Health Foundation. Implementing shared decision making: clinical teams' experiences of
implementing shared decision making as part of he MAGIC programme. London: The Health
Foundation, 2013
2. The Health Foundation. The MAGIC programme: Evaluation. London: The Health Foundation, 2013.
3. Lloyd A, Joseph-Williams N, Edwards A, Rix A, Elwyn G. Patchy 'coherence': using
normalization process theory to evaluate a multi-faceted shared decision making
implementation program (MAGIC). Implement Sci 2013;8(1):102
4. May C, Finch T. Implementing, embedding, and integrating practices: an outline of
Normalization Process Theory. Sociology 2009;43: 535-554
5. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice.
Journal of general internal medicine 2012;27(10):1361-7
6. Elwyn G, Tsulukidze M, Edwards A, Legare F, Newcombe R. Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item. Patient
Educ Couns 2013;93(2):265-71
7. The Option Grid Collaborative. Option Grid. 2016. http://optiongrid.org/ 8. Elwyn G, Lloyd A, Joseph-Williams N, et al. Option Grids: Shared decision making made
easier. Patient Educ Couns 2012;90(2):207-12
9. Elwyn G, Pickles T, Edwards A, et al. Supporting shared decision making using an Option Grid
for osteoarthritis of the knee in an interface musculoskeletal clinic: A stepped wedge trial.
Patient Educ Couns 2016;99(4):571-7
10. Fay M, Grande SW, Donnelly K, Elwyn G. Using Option Grids: steps toward shared decision-
making for neonatal circumcision. Patient Educ Couns 2016;99(2):236-42
11. Patient. What are decision aids? (includes an online database of decision aids). 2016.
http://patient.info/decision-aids. 12. Hargraves I, Montori VM. Decision aids, empowerment, and shared decision making. BMJ
2014;349:g5811
13. Joseph-Williams N, Edwards A, Elwyn G. Power imbalance prevents shared decision making. BMJ 2014;348 g3178
14. Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic
review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns 2014;94(3):291-309
15. Frosch DL, Singer KJ, Timmermans S. Conducting implementation research in community-
based primary care: a qualitative study on integrating patient decision support interventions for
cancer screening into routine practice. Health Expect 2011;14 Suppl 1:73-84
16. Say R, Murtagh M, Thomson R. Patients' preference for involvement in medical decision
making: a narrative review. Patient Educ Couns 2006;60(2):102-14
17. Lifford KJ, Witt J, Burton M, et al. Understanding older women's decision making and coping
in the context of breast cancer treatment. BMC Med Inform Decis Mak 2015;15:45
18. Can consumers learn to ask three questions to improve shared decision-making?: A feasibility
study of the ASK (AskShareKnow) patient-clinician communication model interventionin a
primary health care setting International Shared Decision Making Conference: Pacientes @ the
Centre of Healthcare; 2013; Lima, Peru.
19. Shepherd HL, Barratt A, Trevena LJ, et al. Three questions that patients can ask to improve the
quality of information physicians give about treatment options: a cross-over trial. Patient Educ
Couns 2011;84(3):379-85
20. The Health Foundation. Person-centred care resource centre. 2016. http://personcentredcare.health.org.uk/.
21. Barr PJ, Elwyn G. Measurement challenges in shared decision making: putting the 'patient' in
patient-reported measures. Health Expect 2015; doi: 10.1111/hex.12380. [Epub ahead of print]
22. Barr PJ, Thompson R, Walsh T, Grande SW, Ozanne EM, Elwyn G. The psychometric
properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-
making process. J Med Internet Res 2014;16(1):e2
23. Mcgarrigle H, Lloyd A, Joseph-Williams N, Elwyn G. Making Good Decisions in Collaboration
with patients with breast cancer: the role of Decision Quality Measures and in-consultation decision support tools. European Journal of Surgical Oncology 2012;38(5):441
24. 1000 Lives Plus National Improvement Programme. 2016.
http://www.1000livesplus.wales.nhs.uk/home. 25. Legare F, Ratte S, Gravel K, Graham ID. Barriers and facilitators to implementing shared
decision-making in clinical practice: update of a systematic review of health professionals'
perceptions. Patient Educ Couns 2008;73(3):526-35
26. Department of Health. The NHS Constitution. London: Department of Health, 2009.
27. Hernandez LM. Measures of Health Literacy: Workshop Summary. Roundtable on health