Intended for healthcare professionals


Supporting patients to make the best decisions

BMJ 2011; 342 doi: (Published 07 April 2011) Cite this as: BMJ 2011;342:d2117
  1. Martin Marshall, clinical director and director of research and development,
  2. Jo Bibby, director of improvement programmes
  1. 1Health Foundation, London WC2E 9RA, UK
  1. martin.marshall{at}

Must be a core component of what it means to be a health professional

Imagine an intervention designed to improve patient care that a systematic review has shown to be effective, does not seem to have any serious unwanted effects, has been a central component of health policy for more than a decade, is popular with patients, and which in principle is embraced by most clinicians.

Surprisingly, perhaps, an intervention that meets these criteria does exist, in the form of shared decision making. This is a process in which patients are encouraged to participate in selecting appropriate treatment or management options on the basis of the best available evidence.

For many years policy makers in the United Kingdom have advocated a stronger role for patients, most recently in the NHS constitution,1 and as a central part of the current health reforms, in which “nothing about me without me” has become a defining mantra.2 Other countries are equally committed to the agenda. In December 2010 a group of 58 international healthcare leaders and researchers published the Salzburg statement on shared decision making, calling for a stronger commitment to what they call “co-production of health.”3 To mark the signing of the Salzburg statement on shared decision making the BMJ brought …

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