Intended for healthcare professionals

Feature Essay

Shared decision making: why the slow progress? An essay by Neal Maskrey

BMJ 2019; 367 doi: (Published 05 December 2019) Cite this as: BMJ 2019;367:l6762
  1. Neal Maskrey, honorary professor, evidence informed decision making
  1. Keele University, Staffordshire
  1. nealmaskrey{at}

After more than 40 years of research and policy endorsement, adoption of shared decision making into routine practice has been remarkably slow. Neal Maskrey blames a lack of focus on doctors’ broader communication skills

Shared decision making occurs when clinicians and patients work together to select tests, treatments, management, or support packages, based on clinical evidence and patients’ informed preferences. It involves providing evidence based information about options, outcomes, and uncertainties, together with counselling and a system for recording and implementing patients’ informed preferences.1

Shared decision making has its roots in the ethical principles underpinning clinical practice. In the UK it is included in the NHS Constitution and is a requirement of the doctors’ regulator the General Medical Council (GMC), and it is recommended as usual practice by NHS England and in guidelines by the National Institute for Health and Care Excellence.

Every year from 2009, the healthcare services regulator the Care Quality Commission has asked hospital inpatients whether they were involved as much as they wanted to be in decisions about their care and treatment.2 In 2018 just over 50% of 75 000 respondents answered, “Yes, definitely,” and the pace of any progress seems glacial: about 25% of patients agreed when the CQC asked whether doctors had talked in front of them as if they weren’t there.

Recent Canadian observations of paediatric ear, nose, and throat consultations showed that only half of items that were listed as elements of shared decision making in a validated 12 item scale were present in over 90% of consultations.3 Clinicians were not observed assessing the patient’s preferred approach to receiving information to assist in decision making.

And, given the need identified by the late geriatrician Kate Granger for healthcare professionals to say, “Hello, my name is . . .” at the …

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