Shared Decision making and information reconciliation in The Assessment and Rehabilitation Centre at The Western General Hospital

Introduction:
Patients make different decisions when well informed, which is why shared decision making (SDM) should be at the forefront of healthcare 1 . Recently updated Academy of Medical Royal Colleges guidance for writing directly to patients ‘Please write to me’ 2 highlights the importance of SDM and giving the patient a written summary. In our Assessment and Rehabilitation Centre (ARC) at The Western General in Edinburgh, we wanted to evaluate how well we were incorporating SDM into our practice and learn from service users as to what they would like to see in a summary.

Method:
We used the validated 3 question tool CollaboRATE 3 to evaluate SDM from our patients’ perspective (‘How much effort was made to a) help you understand, b) listen to what matters to you, c) include what matters to you in deciding what to do next?’). We dichotomised results into those giving the top score and less than top score, comparing our practice against other Lothian outpatient settings. We explored information reconciliation from the patients’ perspective, aiming to coproduce a more patient-friendly summary, asking for feedback for our existing summary letter using a combination of open-ended questions and free text.

Results:
We surveyed 5 patients, 80% of whom felt that every effort was made across the three questions asked in the CollaboRATE survey. This is higher than the Lothian top score average of 68%. Regarding our discharge summary, results varied from ‘very useful (40%) to not useful (40%). Levels of understanding of the information varied from ‘all or most’ (60%) to ‘none’ (20%). One patient preferred not to have a summary.

Conclusion:
We are incorporating SDM into our practice but can improve how we summarise that process for our patients and will check whether a summary is actually wanted