Intended for healthcare professionals


Salzburg statement on shared decision making

BMJ 2011; 342 doi: (Published 22 March 2011) Cite this as: BMJ 2011;342:d1745
  1. Salzburg Global Seminar
  1. Correspondence to: Glyn Elwyn, Department of Primary Care and Public Health, Cardiff University, Cardiff, UK elwyng{at}

In December 2010, 58 people from 18 countries attended a Salzburg Global Seminar to consider the role patients can and should play in healthcare decisions.1 Those listed below have agreed a statement that calls on patients and clinicians to work together to be coproducers of health.

Salzburg statement on shared decision making

We call on clinicians to:
  • Recognise that they have an ethical imperative to share important decisions with patients

  • Stimulate a two way flow of information and encourage patients to ask questions, explain their circumstances, and express their personal preferences

  • Provide accurate information about options and the uncertainties, benefits, and harms of treatment in line with best practice for risk communication

  • Tailor information to individual patient needs and allow them sufficient time to consider their options

  • Acknowledge that most decisions do not have to be taken immediately, and give patients and their families the resources and help to reach decisions

We call on clinicians, researchers, editors, journalists, and others to:
  • Ensure that the information they provide is clear, evidence based, and up to date and that conflicts of interest are declared

We call on patients to:
  • Speak up about their concerns, questions, and what’s important to them

  • Recognise that they have a right to be equal participants in their care

  • Seek and use high quality health information

We call on policy makers to:
  • Adopt policies that encourage shared decision making, including its measurement, as a stimulus for improvement

  • Amend informed consent laws to support the development of skills and tools for shared decision making

  • Much of the care patients receive is based on the ability and readiness of individual clinicians to provide it, rather than on widely agreed standards of best practice or patients’ preferences for treatment.

  • Clinicians are often slow to recognise the extent to which patients wish to be involved in understanding their health problems, in knowing the options available to them, and in making decisions that take account of their personal preferences.

  • Many patients and their families find it difficult to take an active part in healthcare decisions. Some lack the confidence to question health professionals. Many have only a limited understanding about health and its determinants and do not know where to find information that is clear, trustworthy, and easy to understand.


Cite this as: BMJ 2011;342:d1745


  • Participants in the Salzburg Global Seminar: Robinah N Alambuya, Shayma Ali, Kathi Apostolidis, Molly T Beinfeld, Sanjay R Bijwe, Paulina Bravo, William Brocklehurst, Rachel Davis, “e-Patient Dave” deBronkart, Anubhav Dhir, Carole R Dodd, Marie-Anne Durand, Simon Eaton, Marjan Faber, Christine M Fisler, Peg A Ford, Marion Grote Westrick, Dance Gudeva Nikovska, Mark A Hendy, Carole Johnson, Robert Johnstone, Steven Laitner, Lydia S Lam, Daniel M Lee, Holly F Lynch, Parag C Mankeekar, Lairumbi M Mbaabu, Layla McCay, Marco Monti, Benjamin W Moulton, Tendani C Muthambi, Jenniffer T Paguio, Tessa Richards, Nadia N Sawicki, Medha S Talpade, Heather W Tesoriero, Ruth Tunick, Eckhard Volbracht, Bruce H Wade, Christopher D Weaver, Richard M Wexler, Biao Xu. Faculty: Michael Barry, Kate Clay, Angela Coulter, Jennifer Dixon, Susan Edgman-Levitan, Glyn Elwyn, Gerd Gigerenzer, Carol Mangione, Roy Moynihan, Albert Mulley, Gary Schwitzer, Anne Stiggelbout, John Wennberg. Staff: Kathrin Bachleitner, John Lotherington, Sinja Strangmann.


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