National Institute for Health and Clinical Excellence (NICE)
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The key to effective shared decision making is to involve people in meaningful conversations about their choices

"Tell me and I forget. Teach me and I remember. Involve me and I learn." Benjamin Franklin

NICE has recently published a guideline on Shared decision making ( (SDM) which defines SDM as a collaborative process involving a person and their healthcare professional working together to reach a joint decision about care. In essence, the clinician provides evidence-based information using a variety of tools and techniques to describe risks and benefits and encourages the person to express their beliefs, values, and choices. In doing so, people using services are empowered to make decisions about their care which is right for them.

A simple, evidence-based model of structuring SDM is the ‘three-talk model’ consisting of the choice talk, option talk and decision talk. This can start before the consultation the person can think about what matters to them and what they would like to achieve from the discussion. During the consultation, the clinician provides further information openly discussing risks and benefits of every option, personalising it to reach a shared decision. This can be done using ‘chunk and check’ and ‘teach back’ methods and further facilitated using Patient Decision Aids (PDAs). Finally, the information is summarised for example via a clinic letter addressed to the person rather than to their clinician. For SDM to be successfully implemented, NICE recommends high level leadership as well as local ‘champions’.

NICE works with over 40 partner organisations to implement SDM in routine practice. One of these organisations is Keele University which has developed an online learning package consisting of a series of interactive modules. Learners can follow these modules in turn or simply dip in and out with the content broken up into discrete bite-sized chunks. Module 6 allows the learner to practice SDM with a virtual patient simulating a real-life clinical situation. 

The key to effective SDM is to involve people in meaningful conversations about their choices. This skill can be challenging to master and requires practice and feedback in a protected environment - the virtual patient consultation is really helpful for this. By making the person and their context central to the interaction and not their condition, this captures the theory of SDM but also complexities of a real-life clinical scenario. We thoroughly recommend giving it a go – the best thing is, you can simply start again if you need to. The computer won’t hold it against you!

Co-authored by Dr Jenni Naisby and Fatema Jessa

Dr Jenni Naisby is a Clinical Support Fellow for the Personalised Care Institute. The Personalised Care Institute provides free education and training for health and social care professionals. They provide a Shared Decision Making e-module. The website provides further details:

Fatema Jessa is the Chief Pharmaceutical Officer’s Clinical Fellow based at NICE.


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