No decision about me, without me

The slogan, ‘No decision about me, without me’, was originally a demand formulated by the emerging patient movement. The current government adopted the ‘no decision’ slogan in its 2010 White Paper, Equity and Excellence: Liberating the NHS

The government wants to place patients’ needs, wishes and preferences at the heart of clinical decision-making.

Why shared decision-making is important?

  • Shared decision-making is viewed as an ethical imperative by the professional regulatory bodies which expect clinicians to work in partnership with patients, informing and involving them whenever possible.
  • There is also compelling evidence that patients who are active participants in managing their health and health care have better outcomes than patients who are passive recipients of care.
  • Shared decision-making is also important for commissioners because it reduces unwarranted variation in clinical practice. Shared decision-making is the principal mechanism for ensuring that patients get the care they need and is the essential underpinning for truly patient-centred care delivery.

Making shared decision-making a reality: No decision about me, without me aims to clarify shared decision-making and what skills and resources are required to implement it and it also outlines what action is needed to make this vision a reality.

The principle of shared decision-making in the context of a clinical consultation is that it should:

  • support patients to articulate their understanding of their condition and of what they hope treatment (or self-management support) will achieve
  • inform patients about their condition, about the treatment or support options available, and about the benefits and risks of each
  • ensure that patients and clinicians arrive at a decision based on mutual understanding of this information
  • Record and implement the decision reached.

The paper outlines the importance of communication skills and sets out how clinicians might approach consultations to arrive at shared decisions. It also suggests that tools that help patients in making decisions are just as important as guidelines for clinicians. In fact, the government officially launched a set of innovative online tools that can help patients make informed decisions about their healthcare.

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