Cluster page — medicines optimisation
Shared decision making in MO practice
Why SDM matters in MO
Without SDM, MO outcomes don't stick
Shared decision making is the operational core of patient-centred medicines optimisation. Every meaningful MO decision — continue this medicine, stop it, switch it, taper it, intensify it — is a decision the patient must understand and consent to. SMRs that fail to embed SDM technically produce correct prescribing changes but consistently underperform on adherence, satisfaction and outcome at 6-month follow-up.
NICE NG197 sets the NHS standard, and the BRAN framework (Benefits, Risks, Alternatives, Nothing) is the most widely used patient-friendly scaffold. Mature PCN SMR templates build BRAN prompts directly into the consultation note and the deprescribing letter.
SDM in the SMR
How a pharmacist actually runs SDM
- Open with 'what matters to you about your medicines?' — not the medication list
- Use BRAN explicitly for any continue/stop/switch decision
- Offer NICE decision aids where available (statins, anticoagulation, antidepressants)
- Document the patient's preference and the agreed decision in the consultation note
- Confirm understanding using teach-back where the decision is complex
- Issue a plain-language deprescribing or switch letter copied to the patient
- Schedule a follow-up to review the decision outcome at 4–12 weeks
SDM impact
What SDM-embedded MO delivers
Frequently asked questions
SDM in MO — FAQs
What is shared decision making?+
A collaborative process in which a clinician and patient work together to make a decision about treatment, balancing evidence with the patient's values and preferences. NICE NG197 sets the NHS standard.
What are the BRAN questions?+
Benefits, Risks, Alternatives, and what if I do Nothing? — a patient-friendly framework promoted by NHS England and the AoMRC to support shared decisions in any clinical conversation, including SMRs.
How does SDM apply to medicines optimisation?+
Every SMR is, in effect, a shared decision-making conversation: continuing, stopping, switching or starting a medicine is a decision the patient must understand and own. Pharmacists who run SMRs without explicit SDM produce technically correct but poorly adhered-to outcomes.
What decision aids exist for MO conversations?+
NICE patient decision aids (statins, anticoagulation, antidepressants), the NHS Right Decision Service tools, and condition-specific Option Grid decision aids. Increasingly built into the SMR consultation template.
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