Option Grids: Expanding our toolkit for supporting shared decision making

I am always looking for new ways to improve the way we support patients to make informed choices about their healthcare, using the best available evidence from research. Shared decision making necessitates information sharing and giving patients a voice in decision making. It is often easier said than done and both patients and care providers need new ways to build better connections. This is, in reality, a huge challenge. Healthcare services are incredibly busy and resources are stretched. Time is limited and conversations are plagued by huge variations in health literacy and language. Fragmented models of care, where patients see different providers at each visit, leads to inconsistencies in information sharing. Patients can become frustrated and confused when information is not standardized and they receive different answers to the same questions, depending on the biases of the different providers they speak with. Then we have the added but influential input from family, friends and the media bring to the mix. We need new tools in our toolkit for providing consistent, evidence-based information, delivered from the perspective of patients.  Providers need tools to lay the foundation for effective shared decision making, in a way that meets an individual’s personal decision making style.

I have recently been exploring Option Grids – decision support tools originated by Glyn Elwyn and others in 2009 at Cardiff University. Option Grids help patients compare treatment options using patient generated frequently asked questions and concise evidence based answers.1 Evidence is gathered from sources such as the National Institute for Clinical Excellence (NICE) in the UK, with the aim for best available evidence to inform the answers to patient questions.1 The grid format provides a short (one-page) easy to read (reading age 10-12 years), easy to use (takes just a few minutes) comparison of options.1 Patients simply work through key questions and answers, comparing their options across the grid. Patients are asked to identify and highlight what questions or issues matter most to them and discuss these key questions in more detail with their provider.1 For more information about the Option Grid Collaborative, at The Dartmouth Center for Health Care Delivery Science in the USA, visit the Option Grid site http://www.optiongrid.org .

The sophisticated simplicity of these decision support tools makes them valuable for a wide range of patient care settings and decision scenarios. In the context of pregnancy care, for example, there are currently Option Grids for decisions about Screening for Down’s Syndrome in Pregnancy, Amniocentesis testing and Newborn Circumcision. Option Grids for contraceptive decision making are currently listed as being under development. I am sure there are many more to come in the future.

Option Grids have great potential for broad application and I can see how they might be useful not only in medical screening and treatment consultations but in many everyday nurse and patient decision discussions. I encourage care providers to check out the web site for a list of currently available Option Grids as well as those currently being developed. Patients need a voice and it is important for nurses and midwives to expand our toolkits to better support patients who might have difficulties knowing what questions to ask or how to ask them. Taking the time, even if it is limited, to identify issues that are important to patients and their families can make a difference to the outcome and experience of healthcare decisions.

Allison Shorten RN RM PhD

Yale University School of Nursing




  1. Elwyn G, Lloyd A, Joseph-Williams N, Cording E, Thomson R, Durand MA, Edwards A. Option Grids: Shared decision making made easier. Patient Educ Couns. 2013; 90 (2): pp. 207–212
  2. Option Grid® http://www.optiongrid.org <accessed October 19th 2014>


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