Intended for healthcare professionals

Education And Debate

Sharing decisions with patients: is the information good enough?

BMJ 1999; 318 doi: (Published 30 January 1999) Cite this as: BMJ 1999;318:318
  1. Angela Coulter, director of policy and development (,
  2. Vikki Entwistle, senior research fellowb,
  3. David Gilbert, research officera
  1. aKing's Fund, London W1M 0AN
  2. bHealth Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD
  1. Correspondence to: Dr Coulter
  • Accepted 15 September 1998

Editorial by Richards and Coulter

Shared decision making, in which patients and health professionals join in both the process of decision making and ownership of the decision made, is attracting considerable interest as a means by which patients' preferences can be incorporated into clinical decisions.1 When there are several treatment options which may have different effects on the patient's quality of life, there is a strong case for offering patients choice. Their active involvement in decision making may increase the effectiveness of the treatment.

Trials are currently under way to test this hypothesis formally, but there are good grounds for optimism. Patients with hypertension benefit if they are allowed to adopt an active rather than a passive role in treatment, 2 3 patients with breast cancer suffer less depression and anxiety if they are treated by doctors who adopt a participative consultation style,4 and patients who are more actively involved in discussions about the management of their diabetes achieve better blood sugar control.5 Patients whose doctors are ignorant of their values and preferences may receive treatment that is inappropriate to their needs.68

Patients cannot express informed preferences unless they are given sufficient and appropriate information, including detailed explanations about their condition and the likely outcomes with and without treatment. Yet many report considerable difficulties in obtaining relevant information.9 There are various reasons for this. Health professionals frequently underestimate patients' desire for and ability to cope with information. Consultation times are limited—there is often insufficient time to explain fully the condition and the treatment choices. Health professionals may themselves lack knowledge of treatment options and their effects. A solution to this problem is to ensure that patients have access to written or audiovisual material, to inform themselves and to use in discussion with health …

View Full Text

Log in

Log in through your institution


* For online subscription