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UK: NICE Guideline: Shared decision making, published June 2021

Discussion in 'Other guidelines with public consultation process' started by Andy, Jun 18, 2021.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    "This guideline covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and people using services to work together to make decisions about treatment and care. It includes recommendations on training, communicating risks, benefits and consequences, using decision aids, and how to embed shared decision making in organisational culture and practices."

    https://www.nice.org.uk/guidance/ng197


    NICE article about the guideline.

    "Shared decision making underpins good healthcare

    Shared decision making between service users and healthcare professionals is an integral part of healthcare, says NICE, in new guideline recommendations published today.

    The new recommendations advise that shared decision making should be part of everyday practice across all healthcare settings. The guideline sets out ways for healthcare professionals to work with people using services to make decisions about their treatment and care, and to ensure this is best practice at an organisational level.

    Shared decision making is a collaborative process that involves a person and their healthcare professional working together to reach a joint decision about care."

    https://www.nice.org.uk/news/article/shared-decision-making-underpins-good-healthcare
     
  2. MEMarge

    MEMarge Senior Member (Voting Rights)

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    This is good timing, with ME GDL coming out in Aug.
     
  3. Sean

    Sean Senior Member (Voting Rights)

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    Depends on how shared and collaborative and joint the decision making actually is. In particular if patients have the right of veto over 'treatment options'.

    But maybe this time. Maybe.
     
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  4. Trish

    Trish Moderator Staff Member

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    It also depends on the person providing the offered treatment being honest and knowing what they are doing.

    How many CBT or GET therapists will tell patients that there is no evidence their treatments do any more than persuade patients to fill in questionnaires differently in the short term, and than following GET instructions has a significant risk of causing long term harm?

    None?
     
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  5. Ariel

    Ariel Senior Member (Voting Rights)

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    I am hopeful about this, but obviously as @Sean says the details need spelling out.

    Made me think - does anyone know when NICE are going to come out with a long covid guideline beyond the rapid guideline from last December? I am really worried about it given the inappropriate treatments and "services" apparently being offered at long covid clinics.

    One would hope that there will be "shared decision making" for LC patients, but many seem to be misled about treatment options or find that services officered are of a different type and nature than expected. Additionally, how can there be shared decision making when neither party (clinician or patient) has accurate information to hand about the condition being treated/managed? Joint decision making is an illusion in a bureaucratic system designed to solve a political problem rather than to meet the healthcare needs of patients.
     
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  6. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I am afraid this looks like window dressing to me.
    I have this awful vision of an ignorant health care worker offering a useless treatment explaining at length how they are going to be terribly nice and friendly and share the decision with me as long as I am terribly nice and friendly to them and do what they want. (The alternative being a slight stiffening up straight and a complete loss of any interest.)
     
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  7. Andy

    Andy Committee Member (& Outreach when energy allows)

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    The Long Covid guideline is developed in a different manner to other guidelines.

    NICE say,

    "Guideline development process


    We are using a ‘living’ approach for the guideline, which means that targeted areas will be continuously reviewed and updated in response to emerging evidence.

    We developed this guideline using the interim process and methods for guidelines developed in response to health and social care emergencies."

    https://www.nice.org.uk/guidance/ng188

    I'm not aware that they explain anywhere what exactly are, and aren't, targeted areas in this guideline. The forum is a registered stakeholder in the guideline but we haven't had any further communication from NICE since this guideline was published.
     
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  8. Suffolkres

    Suffolkres Senior Member (Voting Rights)

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    Caroline S might be interested in this...?

    https://www.nice.org.uk/process/pmg20/chapter/introduction

    Developing NICE guidelines: the manual
    Process and methods [PMG20] Published: 31 October 2014 Last updated: 15 October 2020

    In January 2021, NICE amended the text on assessing new medicines and significant new indications to clarify that this will be carried out in line with the 2019 voluntary scheme for branded medicines pricing and access published on the GOV.UK website.

    In October 2020, NICE amended the text on topic-specific committees to indicate that they may work on multiple guidelines within a topic area, with membership subject to renewal for a total period of up to 10 years.

    In July 2020, we published our NICE interim process and methods for guidelines developed in response to health and social care emergencies.

    In January 2020, we published our new list of NICE's principles. The principles set out our approach to developing guidance, and the ethics and values that should guide the decisions of our advisory committees. They supersede our social value judgements document which was first published in 2005. However, they do not signal a departure from our current methods and approaches: the new principles are consistent with the social value judgements which are in turn reflected in the current version of this manual. The formal process for updating this manual will begin in 2021. Meanwhile, we expect our independent advisory committees to use and refer to the new principles to inform their decisions and provide a clear operating framework.

    ????????????
    Allegedly...........
     
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  9. Barry

    Barry Senior Member (Voting Rights)

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    Inclined to agree. "Shared decision making" is one of those marketing-style phrases that sounds good but can mean whatever those in charge want it to mean. The phrase "shared decision making" is invariably presumed to mean 50:50 shared and well informed decision making, but often it's nothing like that. The patient is invariably at a disadvantage because they rely on unbiased information from the clinician; by no means guaranteed. And some clinicians might make it seem like a patient has played a big part in making a decision, but may well have been manipulated and maneuvered into doing so, possibly without even realising what happened.
     
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  10. Sean

    Sean Senior Member (Voting Rights)

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    I fear many clinicians will simply see it an issue of better bedside manner, a better sales pitch, while not actually doing anything much different from what they want to anyway.

    Not even sure a 'shared' decision makes much sense in this context.
     
    Last edited: Jun 19, 2021
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  11. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Indeed.
    As far as I was concerned as a doctor all the decisions were made by the patient.
    I was just there to explain what was available.
    Why should patients have to share their decisions with health workers?
     
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  12. rvallee

    rvallee Senior Member (Voting Rights)

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    Actual virtue signaling. There is no shared decision-making when one side has 100% of the power. The fundamentals of health care have to be changed to achieve this. This is like a corporate feel-good campaign about their recycling program or whatever, which they then dump in the ocean.
     
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  13. Trish

    Trish Moderator Staff Member

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    While I agree with you on treatments the doctor is offering that the decision should be up to the patient, there is also the situation where a patient asks for a treatment but the doctor refuses it. In that case the decsion is the doctor's.
     
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  14. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I realise that this situation exists. Interestingly, I don't think I ever found myself in it except when NICE refused to let me use the drug I had proven to work! And that wasn't my decision. And for one or two patients I inherited who had become hooked on regular steroid injections that were almost certainly doing harm and no good or drugs like phenylbutazone that we had realised were dangerous. Even then most times I relented having explained my concerns.

    Moreover, I presume that the idea of 'shared decision making' that NICE wants to promote does not include any change in the situation where the doctor feels a treatment is not in the patient's best interest. NICE was set up to regularise that situation. (Which is one of the reasons I think this is window dressing.)

    Where I can certainly see a problem is in things like management of chronic pain. The new position would seem to be 'No there is no way you can have those painkillers but we will share that decision that you can't have them with you.' I can see that being a big issue. My chronic leg pains respond to analgesics. If I needed a prescription I would be pretty cross. Fortunately ibuprofen works quite well and I don't want any of the others because of risks of bleeding or stroke.
     
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  15. Amw66

    Amw66 Senior Member (Voting Rights)

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    Will shared decision making mean shared risk taking ?
     
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  16. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I think that depends on what sort of examples are considered.

    Shared risk taking is something doctors and patients have been doing in discussion for years in rheumatology, where most drugs are risky. Much of the time that is through explaining risks and the patient coming to a decision. For categories of treatment where risk is a routine issue like surgery written informed consent is involved. For drug trials trial licenses and indemnity are involved.

    In general I doubt anything will change or is intended to change with the guideline proposal.
     
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  17. Sean

    Sean Senior Member (Voting Rights)

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    And shared responsibility for the consequences?
     
  18. Wonko

    Wonko Senior Member (Voting Rights)

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    IMO it's just flowery words, that will 'force' surgeries to either employ, or retask, someone to do it for them.

    Probably someone with no or little specific medical training.

    My own surgery has 2 GPs, and around 15 other staff (that I know of), several of whom can seemingly overrule the GPs decisions (at least of mine).

    I can't see the GPs in my surgery having any time to allocate to it, in any way, they are already at something like 3 times the recommended patient/GP ratio for England (due at least partially to losing 2 GPs from the surgery in the last few years who have not been replaced).

    I struggle to see how, in any surgery in England, any of this could possibly occur. They don't have the time to manage a 10 minute appointment, on medical matters, for the bulk of their patients, and now they are 'expected' to also devote time to this. Great idea, if they had time to do so, and the inclination of course, but there is no time for such things to happen in, and most things take time to occur in.
     
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  19. Ariel

    Ariel Senior Member (Voting Rights)

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    <sorry facetious comment to start off>
    Given that it seems likely that nothing much will happen, I'm now wondering whether "nothing" takes time to occur in. In a sense, yes, and in a sense, no. That's the kind of thing I end up thinking about when reading documents like the above.

    To be honest, the phrase "shared decision making" is already extremely patronizing in general, and worrying in a healthcare context. As others have said, it is open to interpretation and could be read as an invitation to manipulate patients into "compliance".

    Better if there are clear-cut statements about what is supposed to happen; it should be explicit that patients are the ones to be making informed decisions about their care. But that is not what was intended here.
     
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