Shared decision-making

Despite the acknowledged benefits of shared decision-making—such as ensuring that client preferences and values are incorporated in care and treatment decisions, improved communication between clients and practitioners, better treatment adherence, increased satisfaction with care and fewer unwarranted variations in clinical practice—not all practitioners engage their clients in shared decision-making (Coulter and Collins, 2011). Coulter and Collins (2011) argued that shared decision-making is an ethical imperative, because it ensures information sharing and working in partnership and is associated with better outcomes.

The NHS Constitution (Department of Health and Social Care, 2015) and other policies for Scotland, Wales and Northern Ireland confirm that people have a right to be involved in decisions related to their care and treatment.The Mental Capacity Act 2005 sets out a statutory framework for decision-making for those who lack capacity in England and Wales, with the accompanying code of practice (Department of Constitutional Affairs, 2007), which provides guidance on the roles of different actors (those appointed by the courts, healthcare and other professionals and untrained staff) in decision-making. The National Institute for Health and Care Excellence (NICE) (2018) published its own guidance, which covers the overarching principles of decision-making, supporting methods, advance care planning, assessment of mental capacity and best-interest decision-making; this should be carefully read to inform practice. More recently, NICE (2019) published a draft scope for consultation for the development of ‘shared decision-making’ guidelines (expected to be published in April 2021), which will cover all clinical settings, including care in the home.