Shared decision-making
Shared decision-making
The case of Montgomery v Lanarkshire Health Board 24 resulted in an increased focus on consent. The law on consent requires a clinician to inform a patient about ‘material risks’ and to find out what that specific patient would want to know. In the case of a child who is unable to consent for themselves, the clinician should inform the person with appropriate parental responsibility for that child about the specific ‘material risks’. For adults lacking the capacity to consent, decisions should be made in accordance with the relevant principles of legislation related to mental capacity.25-27
It is a general principle that healthcare professionals must obtain valid consent before starting treatment or physical investigation, providing personal care, or when providing a prescription for a patient. The process for obtaining consent requires a discussion with the patient about the reasonable treatment options available to them,28 including consideration of the implications of doing nothing, which will in turn facilitate shared decision-making.
This principle is covered in Standards 3.1, 3.2 and 3.3 of the General Dental Council’s Standards for the Dental Team.29 NICE's standard advice on healthcare professionals' responsibilities12 also stresses the importance of offering the most appropriate treatment options in consultation with the patient, while taking into account their values and preferences. NICE guideline 197 (NG197) Shared decision making30 includes advice and recommendations to help embed shared decision making as part of everyday care in all healthcare settings.
Identify possible treatment options and, using your professional judgement and considering the individual circumstances of the patient, ensure that the patient is aware of any material risks and benefits involved in all reasonable treatment options (including consideration of the implications of doing nothing).
- A list of points to cover in your discussion with the patient (see Patient discussion aid) and a patient information leaflet (see Patient information) are available.
Ensure that a contemporaneous note of your discussion with the patient is recorded in the clinical records, including the specific advice given to the patient, details of the options (and benefits and harms) discussed, the patient’s responses and a note of the patient’s autonomous decision.