Embedding a new model of shared decision making in healthcare policy and practice

Addressing the barriers to shared decision making

The 'three-talk' model

Our research team developed a new teaching model designed to guide clinicians on how they could integrate SDM in patient consultations. The ‘three-talk' model was based on three stages of patient engagement:

1. Choice talk ensured that the patient knew that options were available, that they had choice in their decisions, and that their personal preferences were important.
2. Option talk described the options available, including the risks and benefits of each.
3. Decision talk focused on patient preferences, or what matters most to the patient, and sought to arrive at a shared treatment decision.

The SDM Train the Trainer programme

Our research team found that the most important factor in enabling SDM was the attitude and communication skills of the clinician during a consultation. In response, a 'Train the Trainer' programme was established.

This combines skills-training workshops, role play scenarios, and implementation planning. The aim of the programme is for clinicians to develop the necessary attitudes, skills and competencies to routinely embed SDM in clinical practice, with adaptations across different clinical settings.

The role play scenarios help clinicians explore what matters to patients, significantly improving communication of treatment risks and addressing attitudinal barriers. Many clinicians who undertook the training acknowledged that rather than 'doing this already' they could implement SDM much better.

Use of patient decision aids

Our research team also identified the most effective ways to share information about treatment options and risks using patient decision aids.

Patient decision aids aim to provide evidence-based information to help patients understand treatment risks and benefits, allowing them to engage in informed and shared decision making.

Although multiple types of patient decision aids have been developed previously, our team found that the most effective approach was a simple within-consultation format based on frequently asked questions from previously tested tools.

Essentially, this approach lays out the pros and cons of treatment options against the frequently asked questions of patients. When used within a consultation, patients become more involved with the process.

Clinicians described this as a ‘handover’ effect, with patients becoming more confident and engaging in collaborative dialogue when they were passed the decision aid.

A minimum certification standard – the first internationally recognised quality criteria framework for patient decision aids – was developed as a result of the research and was divided into three categories:

1. qualifying criteria – required in order for an intervention to be considered a decision aid
2. certification criteria – without which a decision aid is judged to have a high risk of harmful bias
3. quality criteria – these strengthen a decision aid but do not present a high risk of harmful bias if not met