Eight NHS Trusts working with NHS Direct to pilot online Patient Decision Aids
NHS Direct is piloting three Online Patient Decision Aids (OPDAs) to help patients make informed treatment choices in the first national web-based project of its kind in the UK.
The aim is to help people understand their options, consider the personal importance of possible risks and benefits, and participate in decision making. PDAs have been specifically developed for “preference-sensitive decisions” with significant risks, benefits and uncertainty, where no screening or treatment option has a clear advantage in terms of health outcomes, and each has risks and benefits that people value differently.
Eight pilot sites
Phase one of the PDA pilot has included the development of an OPDA for patients with osteoarthritis of the knee, and the adaptation of two already developed decision aids for patients with an enlarged prostate and localised prostate cancer. All three are currently undergoing service evaluation in the NHS across eight pilot sites* over eight weeks from the beginning of June 2010. Patients who are eligible to take part in the pilot will be given access to the OPDAs via their clinician.
Patients can review all the information, including the pros and cons of the treatment options available, and can view filmed interviews with people who live with the conditions and talk about their choices and consequences, before completing a short questionnaire to assess their treatment preferences. The questionnaire will then be used to support joint decision making between the patient and their clinician.
Subject to the successful completion of phase one, further stages will include the migration of an additional 3 PDAs that have already been developed, but have not yet been implemented in clinical settings, and the development of up to 10 more OPDAs.
A national multi-media NHS solution
The OPDAS are developed as part of a national multi-media NHS solution using NHS Direct’s existing online health and symptom checker infrastructure with telephony and hard copy back up. The pilot will be evaluated by Cardiff University’s School of Medicine. They will determine the most cost effective process of delivering OPDAs, and review their effectiveness, accessibility and acceptability to patients and clinicians, as well as their impact on the wider health service. If the evaluation proves that the online service can deliver benefits to patients and the NHS, it will be considered for national launch.
Mary Archer, Chairman, Urology Informed Decision Making Project, says:
“The decision support programme is remarkable because it opens access to high quality peer approved information and support to help people faced with difficult treatment decisions. Making the programme available online extends access to the decision support service considerably and will enable us to keep it up-to-date with all the latest information.”
Lynn Love, Director of Operations at the National Rheumatoid Arthritis Society (NRAS), says, "Anything that gives information and helps people make more informed choices about their condition, whether that's a form of arthritis or something else, would be a very good thing and we would support that."
Dr Steven Laitner, Associate Medical Director, East of England SHA, says: “Making a decision about the best treatment for you can be difficult. Patient Decision Aids have a proven track record of helping patients and their clinicians to make informed choices. We know that surgery is not always the best option for patients, for example one in five people who have a knee replacement are not fully satisfied with the result. International evidence suggests a 20% reduction in ‘discretionary surgery’ when decision aids are used. I have been working very closely with NHS Direct and other partners to develop the Online Patient Decision Aids and I am keen to see how, using this multi-media platform, we can extend the benefits to more patients and clinicians.”
NHS Direct in partnership
The pilot has seen NHS Direct working in partnership with the NHS Institute for Innovation and Improvement (who provided initial support for the development of all three Patient Decision Aids), East of England SHA, Department of Health, Foundation for Informed Medical Decision Making and BUPA Health Dialog. The Foundation for Informed Medical Decision Making together with Bupa Health Dialog pioneered decision making tools within the USA, which provided inspiration for the development of these OPDAs.
For further information about the online patient decision aid project, please contact your Regional Director.
* The pilots sites for the online Patient Decision Aid (OPDA) for patients with osteoarthritis of the knee are Stanmore Royal National Orthopaedic Hospital NHS Trust, South Tees Hospitals NHS Foundation Trust and Oldham Pennine MSK Partnership Ltd (a service set up in conjunction with Oldham Primary Care Trust). The pilot sites for the other two OPDAs are Cambridge University Hospitals NHS Foundation Trust (Addenbrooke’s Hospital), West Suffolk Hospital NHS Trust, Heatherwood and Wexham Park Hospitals NHS Foundation Trust, Plymouth Hospitals NHS Trust and Stockport NHS Foundation Trust
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