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Pract Neurol 14:54-56 doi:10.1136/practneurol-2013-000666
  • How to do it

Using an Option Grid in shared decision making

  1. Philip E M Smith4
  1. 1Frenchay Hospital, Bristol, UK
  2. 2Cardiff University, Cardiff, UK
  3. 3The Dartmouth Centre for Healthcare Delivery Science, Dartmouth, USA
  4. 4University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Robert Seal, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK; rpseal{at}doctors.org.uk

Introduction

Neurologists make treatment decisions every day; there is a strong ethical case (patient autonomy) for making these decisions jointly with patients.1 ,2 Patients must clearly be closely involved in high-stakes decisions, such as starting chemotherapy and/or radiotherapy for malignant glioma. But there are many lower-stakes decisions where shared decision making can optimise and improve outcomes. Furthermore, there is strong political pressure for efficiency, ensuring the right patients receive the right treatment.3 Thus, patients, policy makers and clinicians each support the principle of shared decision making.1–3 Joint decision making also makes sense from a health and well-being point of view; we feel relatively better when we have more control over events in our lives.

Decision support tools

Although good shared decision making is hard to define and to measure, how we share a decision is very important.2 In particular, ‘patient decision support tools’ can positively impact the quality of treatment decisions. A Cochrane review of such tools (2011 update including 86 randomised controlled trials) showed that increased patient knowledge and improved patient perception of risk helped to ensure that decisions were ‘more congruent’ with patient preferences.4 This research, coupled with the broad public and professional support for shared decision making, suggests clinicians should reconsider how they reach decisions with their patients, and whether they could do better. Option Grids provide …