The dialogue leading to a decision continued
Support from other members of the healthcare team
As decision making is a dynamic, ongoing process, a team-based approach can be helpful in fulfilling patients’ information needs, which may change as their treatment or care progresses.
There may be members of your healthcare team who are expert in certain conditions and their treatment, who are skilled communicators, or who have developed a trusting relationship with the patient. You should consider the role these team members could play in contributing to the dialogue that leads to a decision, while following paragraphs 42–47 on responsibility and delegation.
Responsibility and delegation
You may decide to delegate part of the decision-making process, such as sharing detailed information with a patient about a specific intervention. This type of delegation is routinely used in some multidisciplinary teams for specific interventions.
When deciding whether it is appropriate to delegate, you should consider:
- the nature of the intervention and the complexity of the information about it
- the level of uncertainty surrounding the outcome
- whether the patient has already developed a trusting relationship with you or the person you would delegate to
- anything unusual about the patient’s condition(s) and any concerns that you anticipate the patient may have.
You must make sure the person you delegate to:
- is suitably trained and competent
- has sufficient knowledge of the intervention and its associated benefits and harms, as well as alternative options for treatment and care
- has the skills to have a dialogue with the patient that’s in line with this guidance
- feels competent to carry out the delegated task and understands and agrees that they will refer to you (or another appropriate colleague) for further information, advice or support if necessary.
If part of the decision-making process has been delegated, you are still responsible for making sure that the patient has been given the information they need to make the decision (see paragraph 10), has had time and support to consider it, and has given their consent before you provide treatment or care. You should also check that the patient has a realistic expectation of the outcome.
If a colleague who is sharing information with a patient on your behalf raises concerns about their competence to do this, you should offer support, supervision or training and/or make alternative arrangements.
If a colleague asks you to share information with a patient or seek a patient’s consent on their behalf, you must be satisfied you have the necessary knowledge and skills to do so in line with this guidance. If you’re not, you should explain this and seek support. If you believe you’re being asked to practise outside your competence, or you are insufficiently supported you must consider raising a concern.4