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.

Resource mentioned in this episode

• 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

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.

For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website

Find out more about how I can work with you
If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations.

If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY

I am delighted to open the new season with Professor Jugdeep Dhesi, geriatrician and President of the British Geriatrics Society. Listen in as we explore the changing demographics of dying and the vital role geriatricians play in joining the dots in Advance Care Planning.

This episode is a personal one. I have recently experienced how easily care can become fragmented - and focus on isolated problems rather than seeing the whole person.

I am dedicating this episode to the geriatrician who chose to see the whole person - and in doing so, made all the difference. In her own words: "I am just one of many Geriatricians across the country doing this work every day. I am sure Jugdeep will agree this is 'bread and butter' geriatric medicine that the whole profession should get credit for."

Resource mentioned in this episode

Cost–benefit analysis of implementing comprehensive geriatric assessment enhanced shared decision making into aortic aneurysm pathways

Understanding variation in the management of AAA in the UK: composition and function of multidisciplinary team meetings and information resources provided to patients

Preoperative clinical characteristics and 12-month outcomes following operative or non-operative management of asymptomatic aortic aneurysms

For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website

Find out more about how I can work with you

If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations.

If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY

Exploring words and busting myths associated with palliative and end of life care. Over the course of 10 podcasts I am delighted to talk with Dani Ayre, we focus on a word a week and challenge commonly held beliefs. Why? Because words matter - you will hear the impact of myths around words and we'll share valuable resources.

In our final episode of this season we talk about words used when someone may be approaching the last days of life.

This episode closes the current season. I'll be back on 4th April with more fabulous guests and Conversations About Advance Care Planning.

Resource mentioned in this episode

• David Oliver: What to say when patients are "sick enough to die"
• David Oliver: Public misunderstanding, myths, and misinformation can hamper good end-of-life care
• Better End of Life Report 2024
• Hope for the Best Plan for the Rest
• Death of an Ordinary Man by Sarah Perry
• The Safari Concept

For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website

Find out more about how I can work with you

If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations.

If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY

Exploring words and busting myths associated with palliative and end of life care. Over the course of 10 podcasts I am delighted to talk with Dani Ayre, we focus on a word a week and challenge commonly held beliefs. Why? Because words matter - you will hear the impact of myths around words and we'll share valuable resources.

In our penultimate episode, episode nine we talk about the word "pathway". Listen in and share the conversations.

Resource mentioned in this episode

• Review of Liverpool Care Pathway for dying patients
• Priorities for care part of new approach to care for dying people
• Debunking Myths About Dying with Dani & Clare

For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website

Find out more about how I can work with you

If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations.

If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY

In episode eight we talk about what CPR is, and when it might be considered an inappropriate treatment.

Listen in and share the conversations.

For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website

Find out more about how I can work with you

If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations.

If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY

In episode seven we talk about medication and syringe pumps in the last days of life.

Listen in and share the conversations.

Resource mentioned in this episode

Listen to Anticipatory Prescribing: what it is, what research tells us and what we can do better with Dr Ben Bowers

Read: The Gosport Report

Watch: 'Dying is not as bad as you think' | BBC Ideas By Dr Kathryn Mannix

For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website

Find out more about how I can work with you

If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations.

If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY

Exploring words and busting myths associated with palliative and end of life care. Over the course of 10 podcasts I am delighted to talk with Dani Aye season, we will focus on a word a week and challenge commonly held beliefs. Why? Because words matter - you will hear the impact of myths around words and we'll share valuable resources..

In episode six we talk about nutrition and hydration in the last days of life, listen in and share the conversations.

Resource mentioned in this episode

NICE Guidance available at: Care of Dying Adults in the Last Days of Life QS 144

Dr Kathryn Mannix videos can be found at:

Dying is not as bad as you think

What happens as we die? Kathryn Mannix. TEDxNewcastle

Dying for beginners, Dr Kathryn Mannix

For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website

Find out more about how I can work with you

If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations.

If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY

In episode five we talk about choice and autonomy. Listen in and share the conversation..

Resource mentioned in this episode

Blog: Assisted Dying – an open letter to Esther Rantzen

Read Hope for the Best Plan for the Rest

Access the Waiting Room Revolution podcast

For information about Advance Care Planning, see the Advance Care Planning Explained resource on my website

Find out more about how I can work with you

If you are a team looking to provide better end of life care, or set up a one off or complete education programme in end of life care head to www.speakformelpa.co.uk where I provide details on how I can help you. You will also find information about my Lasting Power of Attorney consultancy and the talks I offer for organisations.

If you enjoy the episode or learn something new, please consider buying me a coffee to go towards making more valuable podcasts: https://www.buymeacoffee.com/6nQVJqVgLY