Shared decision-making and medicines: closing the gap between policy and practice


Shared decision-making is all the rage right now, so it’s great to see this new report written by Professor Alan Cribb from the Centre for Public Policy Research at King’s College London.

There has been broad acceptance for many years that patient-centred care and shared decision-making between patients and healthcare professionals is a good idea, but how well are these policy directives actually working at the coalface?

This discussion paper explores the inherent complexities of increasing patient involvement in treatment decisions, looking through the lens of prescribed medicines and their use.

The analysis of the potential practical and ethical issues that need to be addressed to enable the successful implementation of shared decision-making will be of strong interest to medical professionals.

The report includes a mental health case study that is a structured approach to collaborative planning developed with adults who experience recurring psychotic episodes.

Key conclusions are:

Progress depends upon achieving greater clarity about the range of different purposes and agendas being pursued in the area of medicines and patient involvement. Fudging these different purposes and agendas together under single headings such as ‘shared decision-making’ (or ‘choice’) is often unhelpful and masks the diversity of approaches needed to tailor involvement to specific circumstances and cases and to address practice dilemmas.

The gap between policy ideals and routine practice can only be narrowed if both policy and practice are reformed.

Policy in this area must maintain the strongly reformist, even transformative, zeal of the advocates of patient involvement and shared decision-making. But this zeal needs to be combined with:

  1. a carefully differentiated account of the nature and values of involvement; and
  2. an approach to change that supports and protects these values.

Cribb, A. Involvement, shared decision-making and medicines (PDF). Royal Pharmaceutical Society, November 2011.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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