Intended for healthcare professionals


Implementing shared decision making in the NHS

BMJ 2010; 341 doi: (Published 14 October 2010) Cite this as: BMJ 2010;341:c5146
  1. Glyn Elwyn, professor1,
  2. Steve Laitner, associate medical director2,
  3. Angela Coulter, director of global initiatives3,
  4. Emma Walker, head of service development4,
  5. Paul Watson, chief executive5,
  6. Richard Thomson, professor6
  1. 1Department of Primary Care and Public Health, Cardiff University, Cardiff CF14 4Y, UK
  2. 2NHS East of England, Cambridge, UK
  3. 3Foundation for Informed Medical Decision Making, Boston, MA, USA
  4. 4NHS Direct, London, UK
  5. 5NHS North-East Essex, Clacton-on-Sea, Essex, UK
  6. 6Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to: G Elwyn elwyng{at}
  • Accepted 25 July 2010

Creation of a platform of tools to provide information to doctors and patients should be the first step in giving patients choice about their treatment, say Glyn Elwyn and colleagues.

Policies to promote shared decision making are becoming prominent in the United States, Canada, and United Kingdom.1 2 3 This is partly because of a recognition of the ethical imperative to properly involve patients in decisions about their care4 5 and partly because of the accruing evidence that the approach has benefits.6 Shared decision making is an approach where clinicians and patients make decisions together using the best available evidence. Patients are encouraged to think about the available screening, treatment, or management options and the likely benefits and harms of each so that they can communicate their preferences and help select the best course of action for them. Shared decision making respects patient autonomy and promotes patient engagement.

Despite considerable interest in shared decision making, implementation has proved difficult and slow.7 At least three conditions must be in place for shared decision making to become part of mainstream clinical practice: ready access to evidence based information about treatment options; guidance on how to weigh up the pros and cons of different options; and a supportive clinical culture that facilitates patient engagement. This article outlines some options for creating a sustainable decision support platform for patients that may facilitate a wider adoption of shared decision making in clinical practice.

Decision aids

Interventions to support patient decisions, often called decision aids, have been developed to provide evidence based information to patients.8 These tools are usually designed for situations where there is some uncertainty about the best treatment option and provide information about the harms and benefits in as balanced a way as possible. Some tools are short and …

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