First bullet point is that this should be embedded at organisational level! Includes:
- provide access to patient decision aids (PDAs) or information about risks and benefits
- review how “information systems” might help record discussions and decisions, for example through patient held record
- prompt patients (through media, posters, letters) to ask questions about options, and “making the decision that’s right for me“
- evidence based model eg three-talk model (introduce choice, describe options, help explore preferences and make decision)
- communication skills – avoiding jargon, explaining technical terms
- communicating with families and others the patient would like involved
Note that NHS England has “accessible information standards”.
- Agree an agenda
- Ensure the person understands they can take part as fully as they want in making choices about their treatment or care
- When it comes to tests or treatments, explain what the health care aim is of each option, and discuss how that might align with patients “aims, priorities and wider goals”
- chunk and check information
- check understanding eg teach back
- Give information away at time of discussion or very soon after, including contact details
- Write letters to the patient rather than to their doctor, in line with 2018 Academy of Medical Royal Colleges’ guidance on writing outpatient clinic letters to patients (or at least a copy to patient, unless they expressly don’t want to receive any written information).
- Make clear how information applies to them personally, and how much uncertainty applies
- Use mixture of numbers, pictograms and “icon arrays” (repeated icons, with different colours, to see proportions), to allow people to see both positive AND negative framing
- Be aware that different people interpret terms such as ‘risk’, ‘rare’, ‘unusual’ and ‘common’ in different ways
- Use absolute risk rather than relative risk. For example, the risk of an event increases from 1 in 1,000 to 2 in 1,000, rather than the risk of the event doubles.
- Use 10 in 100, rather than 10%
- Use the same denominator
- State both positive and negative framing