Implementing shared decision making in the NHS

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.