NHS Direct pilot to help treatment decisions

NHS Direct is piloting three online decision aids to help patients facing difficult decisions about test or treatments make informed healthcare choices when there is no clinical evidence that one treatment is better than another and they don't know which will be best for them. International evidence suggests a 20 per cent reduction in 'discretionary surgery' when decision aids are used.

The online patient decision aid (OPDA) will increase patients' awareness of the expected risks, benefits and likely outcomes, empowering them to make informed choices about their care. In turn, this will also help ensure NHS resources are used appropriately.

Phase one of the pilot has included the development of an OPDA for patients with osteoarthritis of the knee, and the transfer to the internet of two already developed decision aids for patients with an enlarged prostate or localised prostate cancer. All three will be trialled in the NHS across eight pilot sites over eight weeks from the beginning of June 2010.

Subject to the successful completion of phase one, and pending intellectual property agreement, further stages will include the transfer online or development of up to six more OPDAs.

At present the only patient decision aids that have been developed across the NHS are for patients with prostate cancer or an enlarged prostate, and these are only available in hard copy. NHS Direct's web-first approach means in the future decision aids can be available in a variety of digital formats such as videos, interactive Q&As and webchats, with additional telephone support available via NHS Direct if required.

Although the pilot will be developed as a stand-alone web service with telephone support, the long-term aim is to develop a national multimedia NHS 'wrap' for OPDAs using NHS Direct's existing online health and symptom checker infrastructure.

The pilot will be evaluated by the University of Cardiff and NHS Direct. They will determine the most cost-effective process of developing the OPDAs, and review their effectiveness, accessibility and acceptability to patients and clinicians, as well as impact on services. 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, said: "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."

Dr Steven Laitner, associate medical director, East of England Strategic Health Authority (SHA), said: "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."

In the pilot NHS Direct worked in partnership with the NHS Institute for Innovation and Improvement, East of England SHA, Department of Health, Foundation for Informed Medical Decision Making and BUPA Dialog.