Shared decision-making in a multidisciplinary head and neck cancer team: a case study of developing Option Grids

Aims: The intended improvement involved introducing a multidisciplinary head and neck cancer team to the principles of shared decision-making, engaging them in skills training and in using patient decision support tools, supporting them to consider how patients could become more involved in treatment decisions about cancers of the head and neck.  Methods: A typical implementation strategy for shared decision-making involves the use of a patient decision support intervention plus efforts to introduce the approach to clinicians, to foster positive attitudes and develop skills in using the materials effectively. However, we were aware of skepticism among some team members. It was decided that this situation required consultation and collaboration, rather than the introduction of a pre-specified intervention. The intervention planning was based on Revans’ Action Learning approach[1]: this has four interlocking elements: 1) a diagnostic phase to identify barriers and facilitators to implementation; 2) a consultation phase to formulate solutions; 3) an implementation phase to roll out agreed actions and 4) a monitoring process. Action learning includes a monitoring process: this was achieved by qualitative data collection to examine the impact of the intervention. The method is described below. Data was collected throughout the 18-month programme. Results: Engaging a multidisciplinary head and neck cancer team in the development of succinct decision support tools, namely Option Grids, increased the team’s understanding and engagement with shared decision-making. The process enabled them to have more confidence in supporting patients to become involved in treatment decisions. The action learning process was particularly helpful because the diagnostic and consultation phases helped the improvement team to understand the complexities of this clinical context. It also enabled members of the MDT to understand the relevance of shared decision-making to this patient group. Conclusions: Although debate continues, the multidisciplinary team agreed that the use of the Option Grids helped patients understand the key features and the risks and benefits of treatment options and to undertake more shared decision-making with patients.