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Practice Guidelines

Shared decision-making: summary of NICE guidance

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1430 (Published 17 June 2021) Cite this as: BMJ 2021;373:n1430
  1. Chris Carmona, technical adviser1,
  2. Joseph Crutwell, technical analyst1,
  3. Marie Burnham, chair of Guideline Committee1,
  4. Louisa Polak, general practitioner2
  5. on behalf of the Guideline Committee
    1. 1National Institute for Health and Care Excellence, London, UK
    2. 2Guildhall and Barrow Surgery, Bury St Edmunds IP33 1ET, and Primary Care Unit, Department of Public Health and Primary Care, Cambridge University, UK
    1. Correspondence to: C Carmona sdmguideline{at}nice.nhs.uk

    What you need to know

    • Shared decision-making requires organisational leadership and planning as well as practitioner skills

    • Shared decision-making is a process requiring a collaborative relationship between patient and healthcare professional; it is not a one-off intervention that healthcare professionals can insert into the consultation

    • Use patient decision aids as part of a toolkit to support shared decision-making

    • Discuss risks, benefits, and consequences of different options in the context of the person’s life and values

    • Be aware that different people interpret terms such as “risk,” “rare,” “unusual,” and “common” in different ways

    Shared decision-making is widely accepted as a core feature of good healthcare. Principle 4 of the NHS constitution states that “Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.”1 Because most NHS practitioners and commissioners acknowledge that this involvement and consultation is not always offered, the National Institute for Health and Care Excellence (NICE) was asked to produce guidance about facilitating shared decision-making and embedding it in everyday practice. For the purposes of the guideline, shared decision-making was defined as “a collaborative process that involves a person and their healthcare professional working together to reach a joint decision about care.”

    This article summarises the recommendations from the NICE guideline.2

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Committee’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Embedding shared decision-making at an organisational level

    Shared decision-making is more likely to become standard practice in organisations when it is led from the highest levels of the organisation. This can drive systematic planning and implementation of shared decision-making across the organisation. A dual approach is needed, promoting shared decision-making to people who …

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