Intended for healthcare professionals


Shared decision making: really putting patients at the centre of healthcare

BMJ 2012; 344 doi: (Published 27 January 2012) Cite this as: BMJ 2012;344:e256
  1. A M Stiggelbout, professor of medical decision making1,
  2. T Van der Weijden, professor of implementation of evidence 2,
  3. M P T De Wit, patient representative 3,
  4. D Frosch, associate investigator 4,
  5. F Légaré, Canada research chair in implementation of shared decision making in primary care 5,
  6. V M Montori, director of healthcare delivery research programme 6,
  7. L Trevena, associate professor7,
  8. G Elwyn, professor of primary care8
  1. 1Department of Medical Decision Making, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands
  2. 2Maastricht University Department of General Practice, CAPHRI School of Public Health and Primary Care, Maastricht, Netherlands
  3. 3Dutch League of Arthritis Patients, Zaltbommel, Netherlands
  4. 4Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
  5. 5Knowledge Transfer and Health Technology Assessment Research Group, Hôpital St-François D’Assise, Québec QC, Canada
  6. 6Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
  7. 7Sydney School of Public Health, University of Sydney, NSW, Australia
  8. 8Institute of Primary Care and Public Health, School of Medicine, Cardiff University Cardiff, UK
  1. Correspondence to: A M Stiggelbout a.m.stiggelbout{at}
  • Accepted 6 December 2011


Although many clinicians feel they already use shared decision making, research shows a perception-reality gap. A M Stiggelbout and colleagues discuss why it is important and highlight some best practices


  • Contributors and sources This paper originated in debates at the sixth international shared decision making conference in Maastricht, Netherlands, June 2011 ( AMS is president of the Society for Medical Decision Making. TVDW was chair of ISDM2011, MDW is patient representative of the Dutch League of Arthritis Patients, DF is associate professor of medicine at UCLA, FL leads research into implementing shared decision making in primary care, VMM designs and conducts trials of patient decision aids in routine clinical settings and is chair of ISDM2013 in Peru (, LT is associate professor at the Sydney School of Public Health, GE works to implement shared decision making at Cardiff, Nijmegen, and Maastricht, Netherlands, and Dartmouth College, USA. AMS drafted the manuscript, and all authors worked collaboratively to contribute, edit, and agree the final version. AMS is guarantor. The authors acknowledge three external reviewers for their comments.

  • Competing interests: All authors have completed the ICJME unified disclosure form at (available on request from the corresponding author) and declare no support from any organisation for the submitted work; GE, DF, and VM have received speaker honorariums, travel allowances, consulting fees, and grants from the Foundation for Informed Medical Decision Making, and GE has a grant from the Health Foundation. They have no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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