#157 Realistic Choice, Shared Decision Making and planning ahead: what evidence and experience tells us with Dr Jude Partridge
Conversations About Advance Care PlanningShow Notes
What is realistic choice and how is this supported by shared decision making? I was privileged to ask Dr Jude Partridge, a consultant geriatrician with the POPS Team at Guys and St Thomas' hospital these questions. Listen in to hear what the evidence tells us, how this can be operationalised and what a tremendous difference it makes.
Resource mentioned in this episode Making shared decision-making a reality No decision about me without me BRAN: helping patients ask the right questions Shared decision making in the Comprehensive model of personalised care Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis Cost–benefit analysis of implementing comprehensive geriatric assessment enhanced shared decision making into aortic aneurysm pathways Preoperative clinical characteristics and 12-month outcomes following operative or non-operative management of asymptomatic aortic aneurysms Working together to provide the care that's right for you. Demonstrating professionalism through approach, behaviours and attitudes of Realistic Medicine Implementing shared decision making according to the choosing wisely programme: Perioperative medicine for older people undergoing surgery Effectiveness of emergency surgery for five common acute conditions: an instrumental variable analysis of a national routine database
Key messages Realistic choice means offering evidence‑based, tailored options that are genuinely appropriate, not an "illusion of free choice".
Shared decision making ensures patients understand realistic options, benefits and harms, then choose based on their own values. Shared decision making is now a legal standard in the NHS personalised care model.
Clinical encounters are power‑imbalanced, we need honest, open communication to level this.
Decisions should follow a holistic assessment (frailty, comorbidities, cognition, function, values).
"Just because we can, doesn't mean we have to" – non‑intervention can be the most appropriate care for a person.
Shared decision making also means positively recommending treatment when it supports what matters most.
Shared decision making relies on strong communication skills and data‑driven discussion of risk and outcomes.
Evidence shows benefits for patients and systems.
People in more deprived areas may benefit especially from shared decision making.
There is a need for better public health messaging on realistic choice and shared decision making.
For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website Find out more about how I can work with you If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations. If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY
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