IDENTIFYING OPPORTUNITIES FOR SHARED DECISION MAKING IN ACUTE MEDICAL ADMISSIONS

Purpose: Shared decision making (SDM) in the acute setting has been limited to a handful of specific decisions. This project aimed to identify opportunities to increase the use of SDM in acute medical inpatients through exploring individual inpatient narratives as their hospital journey unfolded.

Method: This was a qualitative study at North Tyneside General Hospital. Patients with common medical conditions were identified in A&E or acute medical admissions. Participants and/or their family members were interviewed throughout their hospital stay using a semi-structured interview guide addressing: decisions made, patient involvement in decisions, patient satisfaction with decisions and ideas to increase patient involvement. Opportunistic discussions with doctors were held. Contemporaneous notes were made and recurring themes identified.

Result: 31 patients were enrolled and 27 patients completed the study. 6 key themes were identified. The patient journey through hospital was characterised by increasing involvement in decisions from predominantly information giving in A&E, to negotiation and compromise in acute admission unit, to increased participation on inpatient wards. SDM was rarely encountered. Patients were surprised and positive when SDM was enacted. Several participants did not feel it was possible to be any more involved in decisions although others were unhappy with their limited role. SDM was often understood to mean being informed of decisions rather than playing an active role. Patients were broadly very happy with communication skills of doctors. Participants’ expertise, barriers to communication, social support and severity of illness were identified as modifying factors of patient involvement. Some doctors were enthusiastic about SDM in acute medicine while others were dismissive of the idea.

Conclusion: SDM was rarely encountered in acute medical admissions. Even when patients felt involved in a decision this was often mistaken for being well informed. Although many patients were content with this level of involvement, this may have been due to low expectations. This could be addressed by “patient activation” measures. Discontentment with the lack of involvement exhibited by some participants is a further concern as this may disempower the patient and make future SDM harder. White boards at the end of beds, shared notes and “patient road maps” describing the hospital stay are possible ways to increase patient involvement and SDM in the acute setting.