#157 Realistic Choice, Shared Decision Making and planning ahead: what evidence and experience tells us with Dr Jude Partridge

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.

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.

Resource

• 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

  
  

Bio

Dr Jude Partridge works as a consultant geriatrician with the Perioperative care of Older People undergoing Surgery (POPS) team at Guy’s and St Thomas’ NHS Foundation Trust, London, UK where she leads on the POPS-vascular service. She is an honorary senior lecturer at King’s College London with research interests in health services research, delirium and frailty in the perioperative setting and has supervised and examined national and international doctoral programmes. 

She has a wide education and training portfolio, having co-established the first Allied Health Professional, Foundation and Specialist Registrar training programmes in perioperative medicine, co-authored e-learning modules, MSc modules and multiple textbook chapters. She is a frequently invited speaker nationally and internationally and advisor on national guideline groups.