Shared decision making is a process which enables people to make decisions about their health – including the care, treatment or support they receive – in partnership with health and care professionals.
One of the most important, but also most challenging aspects of shared decision making is the communication of risk. Most, if not all care, treatment or support options carry some level of risk, and a shared understanding of that risk is integral to making a shared decision.
The complexities of communicating risk may increase when working with children and young people. Their understanding, preferences and attitudes to risk may change frequently as they grow, develop and mature. Their wishes, needs and feelings may also need to be balanced with those of their parents.
There might not be a shared understanding of what even constitutes a risk. Adolescence is a time of life when boundaries are tested and autonomy is developed, often leading to fundamental differences in how the young person and the adults in their life understand the same situations.
So what does this mean for addressing risk with young people?
There are evidence-based approaches which can help make sure that risk is discussed and addressed effectively:
- Framing conversations in a way that encourages individual responsibility – for instance:
- Giving genuine choice, including explaining what’s not possible and why
- Talking less! Giving the young person time to share their understanding, perspectives and preferences and using these as a basis for the conversation.
- Offering ‘opt outs’ and allowing young people opportunities to change their mind. What works for them at one time may change at a later date – make sure that young people know that they can change their mind and let you know if something’s not working for them.
- Discussions about risk can be some of the hardest to have. If young people are reticent to have difficult conversations, letting them know what other young people in similar situations have wanted to know can be an empathic and helpful way to begin the conversation.
- Offering young people and their parents or carers separate time to discuss their understanding of the risks. They may have different views, and risk can be highly emotive, so offering separate spaces can encourage honesty and help to allay anxieties.
- Finally, using a framework – like the Me First model – can help to ensure that you and the young person develop a shared understanding of the young person’s choices, what’s important to them, and the shared decisions which have been made.
None of the above will make communicating risk easy. It might always remain one of the most challenging aspects of shared decision making, but skilled, empathic communication can help ensure that the process works for the young people themselves, their parents or carers, and their clinical team.
Natalie Koussa leads National Voices’ Wellbeing Our Way programme. She started her career as a child in need social worker and has a background in involving children, young people and parents in commissioning decisions across a Local Authority and Clinical Commissioning Group. Natalie tweets at @nataliekoussa.
 Child and Adolescent Mental Health Service Evidence Based Practice Unit (CAMHS EBPU), CAMHS Outcomes Research Consortium (CORC) and The Health Foundation (date unknown) ‘Closing the Gap: Shared Decision Making in CAMHS’