A decision aid needs a conversation

What we found in the news

NICE's 2021 shared-decision-making guideline (opens in a new tab) describes patient decision aids as support for informed choices. It says they do not direct people toward one option and:

“nor are they meant to replace healthcare professional consultation”

— NICE, NG197, definition of patient decision aids

The guideline recommends relevant, quality-assured aids within a wider approach to shared decisions. We are revisiting that established guidance to consider how a resource reaches the conversation, rather than treating a completed leaflet or screen as a decision in itself.

Why this matters to us

In an illustrative planning conversation, a person has received information about possible care options. They understand the written descriptions but are unsure how each option would fit around their responsibilities at home.

The resource may be doing its job. The remaining question needs a person who can discuss the options and their implications.

At genus, we are interested in the space between information and a choice someone can recognize as their own. Good material can prepare that space. It should also leave room for uncertainty, different priorities and a further question.

Choose the resource for this decision

The responsible professional needs to know whether the aid is suitable for the decision, current and appropriate to the setting. A general educational page is not automatically a patient decision aid.

Explain why the person is receiving it and how it will be used. Will there be a conversation afterward? Who can answer questions about the options? What should the person do if the format is difficult to use?

Offer a suitable accessible format and communication support. A person may prefer to read a short section, hear an explanation or review the material with a chosen supporter. The purpose is participation, not completion of a particular medium.

Avoid presenting a resource as though it contains every consideration that could matter. The person's circumstances may raise a question the aid was not designed to cover.

Bring everyday priorities into the discussion

The person may be weighing practical concerns alongside the professional explanation: travel, time away from work, support at home or the effect on something they value.

Invite those priorities without assuming which one should matter most. A professional may need to explain why an option is appropriate or unsuitable, and the person needs space to describe how they see the choice.

In our illustrative example, the question about home responsibilities could change what support needs arranging before an option becomes workable. It should not be dismissed as separate from the decision.

Check what remains unclear. A person can accurately repeat information while still feeling uncertain about how to weigh it. The next useful step may be another conversation, rather than another copy of the same material.

Clinical options and recommendations belong with the qualified team. This article concerns the communication around a decision, not advice about which treatment or care option to choose.

Record the reasoning that matters to the person

Once a decision is made, the record should accurately reflect what was agreed through the appropriate professional process. Relevant preferences can help the next conversation begin with context.

Avoid reducing a considered choice to a tick beside a resource title. Reading an aid does not establish that the person understood every implication or agreed to a plan.

Explain how and when the decision can be reviewed. A change in circumstances can make an earlier choice worth discussing again. The person should know how to raise that without feeling they have disrupted a completed process.

Managers can review whether staff have enough time, training and access to suitable resources. A library of excellent material is useful only if people can find the right item and discuss it appropriately.

The genus connection

Today, configured genus resource experiences can make an organization's reviewed content available for people to revisit before or after a conversation. Available tools can support the surrounding arrangements and follow-up.

The presence of a resource does not make it a validated decision aid or replace professional consultation. Organizations must review content, choose the appropriate audience and establish how individual questions will be handled.

We see the useful role as helping someone arrive with more context and return to an explanation afterward, while keeping the decision anchored in a conversation about what matters to them.

One question to take away

When your team shares a decision resource, is the person clear about the conversation that comes next?