Person-centred care: from ideas to action : The Health Foundation

Bringing together the evidence on shared decision making and self-management support

Author’s:- Dr Nahid Ahmad, Dr Jo Ellins, Holly Krelle and Michael Lawrie

Published:- October 2014

This report seeks to bring together the evidence on shared decision making and self-management support, with the aim of providing greater coherence and clarity in debates about person-centred care.

To download the report:-  Person-centred care: from ideas to action


Decision aids, empowerment, and shared decision making

BMJ 2014;349:g5811

Ian Hargraves, lead designer, Victor M Montori, professor of medicine

Finding unexpected results when testing our ideas is the basis of learning, experimentation, and scientific method. In a linked paper (doi:10.1136/bmj.g5651), Denig and colleagues report on a randomized trial of a decision aid for patients with type 2 diabetes.After much well executed work in the development and testing of this decision aid, the authors concluded that it had a trivial, if any, effect on patient empowerment. What might we learn from this?

To download this report:- Decision aids, empowerment and shared decision making


Invisible Risks, Emotional Choices — Mammography and Medical Decision Making

Lisa Rosenbaum, M.D.

N Engl J Med 2014; 371:1549-1552October 16, 2014DOI: 10.1056/NEJMms1409003

This article is published in The New England Journal of Medicine

How do we balance the goal of engaging women in decision making with the reality that emotions play a powerful role in shaping our understanding of benefit and risk?

To read the article:- Invisible Risks, Emotional Choices – Mamography and Medical Decision Making 


The Role of Maternity Care Providers in Promoting Shared Decision Making Regarding Birthing Positions During the Second Stage of Labor

Marianne J. Nieuwenhuijze RM, MPH, Lisa Kane Low CNM, PhD*Irene Korstjens PhD and Toine Lagro-Janssen MD, PhD

This article first published in the Journal of Midwifery & Woman’s Health in May 2014.

Through the use of a variety of birthing positions during the second stage of labor, a woman can increase progress, improve outcomes, and have a positive birth experience. The role that a maternity care provider has in determining which position a woman uses during the second stage of labor has not been thoroughly explored. The purpose of this qualitative investigation was to explore how maternity care providers communicate with women during the second stage of labor regarding birthing position.

To access the abstract or to download the full article from the Wiley Online library: – The Role of Maternity Care Providers in SDM 

A qualitative analysis of implementing shared decision making in Child and Adolescent Mental Health Services in the United Kingdom: Stages and facilitators

Clin Child Psychol Psychiatry 1359104514547596, first published on September 1, 2014

This article has recently been published by Sage Journals and is available online.  It  explores the implementation of shared decision making (SDM) in Child and Adolescent Mental Health Services (CAMHS), and identifies clinician-determined facilitators to SDM.

To view the abstract:- SDM in Child and Adolescent Mental Health Services

To download the full article:-  A qualitative analysis of implementing shared decision making in Child & Adolescent Mental Health Services


Bristol Physios champion Shared Decision Making

Physiotherapists in Bristol are using patient feedback to make changes to their service and promote shared decision-making. The initiative is at Bristol Community Health, a community interest company and provider of adult community services in Bristol. The company is conducting research to measure how much shared decision-making occurs in physiotherapy consultations. Following initial findings, the company has set up a course for all staff to help explain the approach and has developed visual materials for patients with mild to moderate learning difficulties.

For more information about this approach:-  Bristol Physios-SDM



GP Tutorial Extra – Shared Decision Making

The Thames Valley Knowledge Team have provided information  for a useful aid for Shared Decision Making for GP’s. The 4th edition of a publication for GP’s called Tutorial Extra is produced by Southampton City Clinical Commissioning Group. It is designed to help Southampton General Practitioners and Primary Care Clinicians by providing them with guidelines about common clinical areas  and to highlight other sources of information available.

In this Tutorial Extra the red highlighted texts (separated by commas) are multiple links to Patient Decision Aids or Shared Decision Making Sheets.  By following the links, you will be able to access and print out sheets for helping patients make informed decisions with  their GP or Primary Care Clinician, on a wide range of common conditions.

To access this resource:- Tutorials Extra Issue 4 – Shared Decision Making


AQuA – SDM Case Studies 2013/2014

AQuA have produced a number of case studies illustrating the successes and challenges experienced by those implementing Shared Decision Making and Self-Management Support in practice. Clinical Teams involved in the 2013/14 SDM Collaborative have contributed to these case studies.

To find out more information about these projects, you can access the AQuA website:-

or contact AQuA by email at:


A research group working at The Dartmouth Center for Health Care Delivery Science and The Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College, led by Professor Glyn Elwyn have developed CollaboRATE, a patient-reported measure of shared decision making.

Measuring the level of shared decision making in the clinical encounter from the patient’s perspective is an essential part of assessing health care quality and provider performance.

CollaboRATE contains three brief questions that patients, their parents, or their representatives complete following a clinical encounter. CollaboRATE is suitable for use both in research and in routine health care delivery.

To find out more information:-


Webex 6th February 2014 – Shared Decision Making in MSK; A perspective from a Patient Organisation.

Siobhain McCurrach, Arthritis Care Area Development Manager for South of England,  shared her experience of Shared Decision Making in MSK services from the Patient Organisation’s perspective. Siobhain also answered questions from the audience.

Siobhain is Arthritis Care’s Area Development Manager for South England.  Siobhain is responsible for the day to day running of Siobhain McCurrachthe region’s activities and the support offered for people with arthritis.  Siobhain has been working for Arthritis Care since 2006 and started off in the role of Regional Campaigns Manager for South East England.  Typically in South England, Siobhain and her small team of staff provide information on arthritis and how to self-manage their condition, self-management training workshops in community settings (to help people develop an understanding of their condition and set personal goals) and campaigning work to raise awareness of the needs of people with arthritis.  There are 41 branches and 49 volunteers in South England, with whom Siobhain and her team are in regular contact. Apart from generic service provision in South England, Siobhain is project lead for Arthritis Awareness (1 hour workshops for frontline service staff to better understand the needs of people with arthritis), Arthritis Watch (patient feedback on access to and quality of health services in England for people with arthritis) and Arthritis Care’s PPI (Patient and Public Involvement) Mobilisation Strategy across England.

Siobhain addressed the South Central SHA in 2010 at their Informed Decision Making conference and stressed the need for patients to be fully informed of their condition so they could participate in Shared Decision Making.

If you missed the event there is an opportunity to view the presentation and listen to the recording:-

This Webex was supported by Pfizer Ltd under a medical education goods and services contract.

For further details about Arthritis Care:-

Arthritis Care website:-

Arthritis Care webpage for health professionals:-

Arthritis Care Freephone Helpline:-

  •  (0808) 800 4050  (10am – 4pm Mondays to Fridays) free from all landlines and most mobile networks.

The Helpline can be emailed as well for information and support:-

The two documents below give evidence of the impact of self management support through the ‘Challenging Pain’ workshop:-

The following documents provide details of the Challenging Pain workshops:-



Webex  14th January 2014 – My challenges and opportunities in inheriting the national Shared Decision Making programme:- or “Don’t throw the baby out with the bathwater”.

JaneJane Fox, Policy Officer and Lead on Shared Decision Making  from NHS England joined us to share her experience of  recently taking on Shared Decision Making at a national level and the challenges and opportunities this has presented. Jane also covered where the programme is going next and answered questions from the audience.

Jane Fox joined NHS England in July (2013) returning to NHS policy after an opportunistic career break to be a full time mum. Jane previously worked for Skills for Health and before that the Department of Health, leading and supporting a wide range of policy areas as diverse as dementia, 18 week waits, the Carer’s Strategy, cancer, end of life and urgent care. Her wide ranging experience of policy development and policy implementation, in particular the workforce aspects, enables her to bring her knowledge and experience with a fresh perspective to Shared Decision Making.
If you missed the event there is an opportunity to view the presentation and listen to the recording:-


List of Option Grids currently in development: January 2014

Option Grids are brief easy-to-read tools made to help patients and providers talk about difficult decisions. 

Option Grids help you find answers to patients’ frequently asked questions.

More Option Grids are being developed, using a collaborative approach. Each Option Grid is led by an editor, working in liaison with patients, patient organisations and relevant clinicians.

Here is a list of option grids currently in development:-


The Cochrane Collaborative

Shared decision making for acute respiratory infections in primary care (Protocol)

To assess whether shared decision making increases or reduces antibiotic prescribing for ARIs in primary care

Coxeter P, Hoffmann T, Del Mar CB. Shared decision making for acute respiratory infections in primary care (Protocol). Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD010907. DOI: 10.1002/14651858.CD010907.


Full Article:


Webex 10th December 2013 – Shared Decision Making: Our experience at Aintree

Stephen BuntingStephen Bunting, Physiotherapy Extended Scope Practitioner at Aintree University Hospitals NHS Foundation Trust joined us on 10th December 2013 to share his experience of implementing Shared Decision Making into their Musculoskeletal Clinical Assessment Service (MCAS).

If you missed the event there is an opportunity to view the presentation and listen to the recording:-

Stephen’s Presentation:-

Stephen has also kindly shared the documents that he referred to in his presentation and these are available here:-

For more information about other option grids available:-

The AQua SDM case study of the teams experience as part of the National SDM Collaborative in 2012/13 can be found here:-

For information about other case studies on Shared Decision Making:-


Webex 20th November 2013 – Integration of Shared Decision Making within primary care in NHS Trafford: a practical guide

This Webex was supported by Pfizer Ltd under a medical education goods and services contract.

Louise RogersonOn 20th November 2013, Louise Rogerson, Physiotherapist, Scheduled Care Commissioner at  NHS Trafford and now Director of Service Development at Intelesant, joined us to share her experience of Shared Decision Making via a Webex. Louise’s presentation  was a practical guide on how shared decision making was integrated into primary care in NHS Trafford for MSK services. Louise described the problems encountered and the methods used to implement SDM in primary care. Also the key messages and lessons learnt from the experience were shared. The audience was then able to ask Louise questions.

If you missed the event, there is an opportunity to view the presentation and listen to the recording and documents shown in the presentation are included below.

The presentation for the event:

The recording of the event:-

If you would like a copy of the optiongrid that NHS Trafford produced:-

If you would like a copy of the poster that NHS Trafford produced:-

SDM GP recruitment pic

SDM GP recruitment pic

SDM GP recruitment pic






The AQua SDM case study of the clinical teams experience as part of the National SDM Collaborative in 2012/13


Thames Valley Health Project report – Embedding shared decision making in primary care

Our latest project report on shared decision making is now available and has been recently promoted on the Guardian website.


For more information about our other project reports:-

If you would like a hard copy of any of our reports sent to you,

please contact:


Patient Story

No decision about me, without me – Jean’s Story

To read Jean’s experience of shared decision making and to view a short film or to to find out about other patient stories on shared decision making:- Patient Stories 


Alison Kent

Webex 10th September 2013 – Implementation of SDM in Secondary Care : A Case Study in Rheumatology

On 10th September 2013, we were delighted that Alison Kent (Rheumatology Nurse Specialist) from Salisbury NHS Foundation Trust Hospital was able to join us to share her experience of Shared Decision Making via a WebEx with our Community of Interest. Alison’s presentation looked at:- How and why shared decision making should be an integral part of the care of patients with inflammatory arthritis and also at identifying the barriers faced in implementing shared decision making in secondary care and discussed ways to overcome these barriers. This was followed by an opportunity for the audience to ask Alison further questions. If you missed the event, there is an opportunity to listen to the WebEx and to view her presentation on the following page:- WebEx details – 10th Sept 2013


Cancer patients want more shared-decision making about their treatment

A new study of cancer patients indicates that certain patient groups have unmet needs for greater involvement in decisions about their treatment  according to new research being published in the British Journal of Cancer.

To read more:-


AQuA – SDM Case Studies

Several of the clinical teams that were involved in the National SDM Collaborative in 2012/13 have contributed to case studies about their experiences:


Webex – 17th June 2013, with Dr Steven Laitner

We were delighted that Dr Steven Laitner shared his experience on Shared Decision Making including the difficulties with embedding best practice and how to overcome barriers to change when implementing Shared Decision Making. He also talked about the latest developments in Shared Decision Making and answered questions from the audience. The webex took place on Monday 17th June 2013, from 13:00 to 14:00.

This Webex was supported by Pfizer Ltd under a medical education goods and services contract.

Dr Steve Laitner

Steven Laitner is a General Practitioner with a public health and clinical leadership background. 

Steven was until recently the National Clinical Lead for Shared Decision Making as part of the Department of Health QIPP Right Care programme. 

He also provided clinical leadership to DH and NHS Midlands and East on the Accountable Lead Provider model of care. Steven supported NHS Bedfordshire in their MSK Accountable Lead Provider commission. 

His medical interests include care pathways, health care systems, demand management, patient access, long term conditions, patient empowerment, patient leadership and Shared Decision Making. 

Steven now works as both a general practitioner and a freelance health consultant.

The webex was an opportunity to ’Ask an Expert’ about Shared Decision Making.

If you missed the event, the presentation is now available to download:-

Also you can hear the recording of the webex by following this link:-

Your Health – Your Decision

Evaluation and Output Report of the AQuA Workstream within the National Shared Decision Making Programme is now available.

“AQuA was delighted to win part of the Department of Health QIPP Right Care National tender for Shared
Decision Making in the crucial area of culture change. The programme has been very successful in delivering
culture change, patient empowerment and tools to measure Shared Decision Making in everyday clinical
practice, in a range of settings and clinical pathways.”

This report tells the story of AQuA’s work over the past year 2012/2013.



The MAGIC programme: evaluation

The Health Foundation’s MAGIC (Making good decisions in collaboration)programme aims to support clinical teams in primary and secondary care to embed shared decision making with patients in their everyday practice. This independent evaluation by the Office for Public Management (OPM) covers the first phase of the programme.
Published: April 2013
MAGIC evaluation.gif

Shared decision making: What might go wrong when decisions are not shared?

Healthtalkonline: Sharing patients experience of when communication breaks down between clinicians and patients and decisions are not shared.

“…we look at what can go wrong when people want to be involved in sharing treatment decisions but it does not happen. Although there are various barriers, by far the main reason why it fails is poor communication between patients and doctors.”


Lessons from patients’ journeys: Report in the BMJ

BMJ 2013;346:f1988 (Published 3 April 2013)
Peter Lapsley, patient editor, BMJ

Peter Lapsley, patient editor at the BMJ, reflects on the lessons that have emerged from the first 100 articles in the Patient’s Journey series

“Over the past seven or eight years, I have been helping patients to get their stories published, obtaining doctors’ perspectives on them, and, with colleagues, developing the guidelines for drafting patients’ journeys, hoping that these might increase the usefulness of such articles to doctors (box).”

Full article is available here:-


Measuring Shared Decision Making – A review of research evidence

This is a report for the Shared Decision Making programme, In partnership with Capita Group Plc.

There is a wealth of research evidence around Shared Decision Making: its purpose, the need for it and evidence of its benefits and challenges.  This report aims to complement existing literature and evidence, by focusing on measurement and evidence of implementation in England to date. In doing so, our objective is to support those with an interest in developing Shared Decision Making within their organisations, to help them to understand:

• What elements of the decision making process should be measured, including for example, decision readiness and decision quality
• What measures exist and what research evidence supports their use
• What evidence is there of the implementation of  these measures, and in what contexts?
This report provides a summary of the types of  measures that are available, a recommendation of which measures might be appropriate for the national programme as well as a rationale for the suggested approach.


Webex with Dr Alf Collins on 16th April 2013

Engaging with patients in shared decision making about their care and treatment choices is a challenge for CCGs. As part of the South of England Shared Decision Making programme, colleagues were offered an opportunity to join a free WebEx with Dr Alf Collins. This was an opportunity to hear from an expert about implementing Shared Decision Making and to ask questions about the challenges you have with SDM. The webex took place on Thursday 16th April 2013, from 13.30 to 14.30.  
This Webex was supported by Pfizer Ltd under a medical education goods and services contract.

Alf Collins is a community based consultant in pain management in Somerset.

He has contributed to the development of DH self-management support and Long Term Conditions policy since 2003 and was chair of the DH/SHA self-care network from 2006-7. He was a clinical advisor and contributor to the national LTC QIPP workstream and the national Shared Decision Making workstream and, with Angela Coulter, wrote an in-depth review of shared decision making for the Kings Fund in 2011. More recently, he has acted as advisor to the Domain 2 (LTC) team of the National Commissioning Board.

He works very closely with the Health Foundation, was national clinical lead of their patient engagement programme ‘Co-creating Health’ and is now Clinical Associate and Board Advisor to the Foundation.

The webex was an opportunity to ‘Ask an Expert’ about Shared Decision Making, by asking questions and sharing the dilemmas, successes and challenges you have with SDM. The discussion was led by Dr Alf Collins with contributions from David Pennington from NHS South of England.

If you missed the event, the presentation is now available to download:-

Spreadsheet of available PDAs, BDAs and Option Grids – NHS South of England

We are pleased to provide for colleagues this ‘quick find’ spread-sheet of all decision aids that have been published in the UK either by Totally Health or the Magic Programme. The spreadsheet has been produced by NHS South of England.  The decision aids have been categorised under the key areas of cancer, MSK, surgery and medicine to assist you in quickly establishing if an aid exists for a specific condition and provides a link to the tool.

The decision aids are listed twice- on the initial total list page of the workbook  all the aids are in alphabetical order with links provided to the individual decision aid.  Secondly, the relevant aid can be found under the different categories, again with a link to the tool.

This spread-sheet will be updated as new decision aids are launched.


New Apps  for Patient Decision Aids

Apps on PhoneThe Patient Decision Aids have associated Apps, with versions for Android and Apple devices. Patients can download them from the Google Play Store or iTunes from your device (search for “patient decision aid”). This allows information to be accessible anywhere.




Latest National Newsletter for the Shared Decision Making Programme –  March 2013

The Right Care programme produces regular newsletters and updates. For the latest newsletter:-


Online Shared Decision Making Training – e-learning resource

This e-learning resource provides guidance on what Shared Decision Making (SDM) is and how to implement it in practice. It also provides resources to help health professionals learn the required skills. The e-learning sessions include films to illustrate examples of good and bad consultations and prompts, along with resources to aid health professionals with their work.

Who is this tool for?

The Shared Decision Making e-learning package is suitable for all healthcare professionals, health improvement personnel and patient engagement representatives to inform and educate them on Shared Decision Making in order to embed it in day to day clinical practice. Shared Decision Making represents a cultural change in behaviour and this tool will aid and assist in changing  an environment of medical paternalism to a more inclusive approach based on the 2012 Health Act ‘Liberating the NHS: ‘No decision about me without me’.

To access this on-line resource:-

Shared Decision Making to Improve Care and Reduce Costs: Report in the NEJM

Emily Oshima Lee, M.A., and Ezekiel J. Emanuel, M.D., Ph.D.

N Engl J Med 2013; 368:6-8January 3, 2013DOI: 10.1056/NEJMp1209500

NEJM perspective on why more rapid progress on shared decision making in healthcare is needed.

Studies also illustrate the potential for wider adoption of shared decision making to reduce costs. Consistently, as many as 20{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} of patients who participate in shared decision making choose less invasive surgical options and more conservative treatment than do patients who do not use decision aids” p7

Latest National Newsletter for the Shared Decision Making Programme –  January 2013

The Right Care programme produces regular newsletters and updates. For the latest newsletter:-


Government response – No decision about me without me – 13th December 2012

Publication of the DH’s response to the No decision about me, without me consultation was released on 13th December 2012.   This can be found on the DH website alongside the new DH Choice Frameworks:

This response is the culmination of nearly two and half years of work stretching to two consultation exercises from the White Paper, through the Listening Exercise to the Mandate.

The Choice Frameworks are the first to be published under the Open Public Services agenda, and span 2012/13  (in place now) and 2013/14(which takes account of the changes within the NHS that will be in place by April 2013.

Embedding Shared Decision Making: A Resource Pack for Commissioners

This document has been developed by Capita as part of the national Shared Decision Making Programme, which is part of the Right Care Programme. This document is a resource pack for commissioners and outlines the steps to embedding Shared Decision making across your local health economy.

This resource pack has been tested on the ground with commissioners, including Clinical Commissioning Groups, who focussed on developing a Shared Decision Making approach across their health economy. This resource pack aims to provide practical advice and support. You will need to consider having appropriate people to support the implementation of change. Having a clinical lead for this work with commitment to the principles of Shared Decision Making and influence across the health system is vital.

If you have any problems opening any documents in the resource pack then please contact:-


Sharing Shared Decision Making Resources – Training Workshops

AQuA and Capita in their role as contractors to the national programme have been developing tools and resources to support clinicians and commissioners in implementing SDM.

Their area of focus has been:-

AQuA- Develop a training and education programme for providers, including nurses,

GPs, Consultants and NHS managers, as well as commissioners

Capita- Embed Shared decision making in NHS Systems and processes

Three interactive training workshops took place in January 2013 at:

Taunton on 10th January 2013

Southampton on 11th January 2013

Bristol on 14th January 2013

The events were well received by those that attended with participants planning to take the information and share with colleagues in their workplaces.

Two further training events are planned for March 2013.

Please follow the link for further information:-

Webex – 13th December 2012

Engaging with patients in shared decision making about their care and treatment choices is a challenge for CCGs. As part of the South of England Shared Decision Making programme we were pleased to offer colleagues an opportunity to join a free WebEx with Angela Coulter. This took place on Thursday 13th December 2012, from 13.00 to 14.00.  

Angela Coulter is known nationally and internationally for her work over 20 years on shared decision making, and holds a number of national and international roles.  In her Oxford University role she is studying the effects of personalised care planning and shared decision making for people with long-term conditions. She has published more than 250 research papers and reports, and several books, including Making Shared Decision-Making a Reality, No decision about me, without me. She is also involved in the national SDM programme and helped the Health Foundation establish the MAGIC project.

If you missed the event, the presentation is available to download:-

A recording of the webex will be coming soon!


Building health partnerships: call for expressions of interest

Engaging with voluntary and community sector organisations is recognised as a significant aspect of delivering improved health outcomes for their communities

The NHS Commissioning Board, together with NAVCA (National Association of Voluntary and Community Action) and Social Enterprise UK (SEUK), are looking for up to 12 CCGs who are committed to delivering improved health outcomes for their communities by building effective community involvement in commissioning to express an interest in becoming a learning site.

A link and attachment is provided if you wish to consider this initiative-

Please note 14th December deadline if you are interested.


Progress news from Southampton CCG:-

Southampton CCG have been working with one of the national contractors to progress the implementation of SDM. They have written an update paper which sets out the challenges they have faced and the changes to their plans as a result. It also highlights to the key risks they are facing to making further significant progress.

Your views and comments on this would be useful. It may be an area with which you have made progress- so can offer assistance. Or are you faced with similar challenges?

This may be something we need to raise formally with the national programme as a common barrier to progress.

Please send any comments to




Rightcare SDM Programme – Four New Patient Decision Aids Launched

Four new decision aids have been launched. These are:-

There are now 10  patient decision aids available to use. For more information:- PDAs


The Health Foundation

The Health Foundation have launched a  new Shared Decision Making resource centre.

This resource centre is packed with information and practical resources to support individuals and teams put shared decision making into practice.

National Shared Decision Making Webex Event (Aqua)

Presentations from the recent Webex held on 6th November 2012:-

Presentations from the Webex held on 11th October 2012:-

If you would like more information about these WebEx’s, please contact


Latest National Newsletter for the Shared Decision Making Programme –  September 2012

The Right Care programme produces regular newsletters and updates. For the latest September newsletter:-


Rightcare SDM Programme – New Patient Decision Aids Launched

The national Shared Decision Making Programme launched on 19th September 2012,  five new Patient Decision Aids.

See the attached Press release for details:-

The Department of Health

The Department of Health has a consultation on Shared Decision Making running until 31 st August 2012.

Liberating the NHS: No decision about me, without me – Further consultation on proposals to secure shared decision-making

Further details about the consultation can be viewed here:-


ASK 3 Questions

Ask 3 question has now been adopted as a key tool for engaging the public and supporting a culture change. It was launched on 6th September 2012 and the supporting materials available to download can be found here.


Latest National Newsletter

The Right Care programme produces regular newsletters and updates. For the latest newsletter:-


On-line Survey

Many thanks to those of you who found the time to complete the survey, your responses are invaluable to us.

Whilst the response rate was not high, for the majority of those that did reply- SDM does feature in CCG plans, many have a SDM lead, and want to be linked with others doing similar work.

The full report can be found here:-

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