Implementing shared decision making according to the choosing wisely programme: Perioperative medicine for older people undergoing surgery

Background: Shared decision making (SDM) is the process whereby patients and healthcare professionals work together to achieve a consensus management decision, based on best clinical evidence and patient's preferences. No formal approach to documentation of SDM conversations exists in setting of peri-operative medicine. Objective: To assess and improve the quality and consistency of documentation regarding SDM conversations in an elective surgical outpatient population and appraise the satisfaction of patients and professionals in SDM. Methods: The study was conducted in a geriatrician led perioperative medicine for older people undergoing surgery service, at an inner-city teaching hospital serving a tertiary surgical referral population. The quality improvement programme intervention comprised a Choosing Wisely, UK SDM tool, consisting of Benefits, Risks, Alternatives and Doing Nothing (BRAN mnemonic), clinic posters, patient leaflets, and an introductory SDM workshop and education sessions, and observation and standardised feedback of SDM. Clinic letters were reviewed to identify SDM documentation compliance. Participants included clinicians of all grades and disciplines, and consecutive patients attending the clinic. Results: Clinician interviews revealed inconsistent documentation of SDM. We reviewed 203 clinic letters following the initial implementation of SDM documentation tool, only 59% (n = 120) had fully completement BRAN tool. Additional interventions improved clinic SDM documentation compliance to 98%. A prospective observation study conducted revealed patients and clinician satisfaction at 93% and 79%, respectively. Conclusion: The BRAN tool is adaptable to many health decision settings, including discussions related to treatment, investigations, and procedures, which expands its potential to improve patient safety.