Sharing decisions
The benefits of shared decision-making
Evidence shows that sharing decisions can be highly beneficial to patients. Patients who are involved, as much as they wish to be, in decisions about their care and treatment are more likely to feel:
- knowledgeable
- able to manage their condition
- satisfied with the quality of their care.
They are also more likely to take part in preventive schemes, and to follow the course of treatment agreed with their clinicians.
Picker Institute Europe has argued successfully for the adoption of shared decision-making within Good Medical Practice, and as an extension of the Department of Health in England's 'choice' policy agenda. The NHS Constitution for England states that:
The aim of shared decision-making
Shared decision-making secures the most appropriate course of care and treatment by involving patients - as much as they wish to be involved - in decisions about their care and treatment. It is appropriate in all those situations when:
- there is more than one reasonable course of action
- no single option is self-evidently the best one to choose
- different options have different benefit:risk profiles
- patients' values, preferences and attitudes to risk are relevant to the decisions about whether and how to treat.
Although there have been some encouraging policy advances, 
trend data from patient experience surveys show that shared decision-making is not always widely practised and represents a major unmet challenge to the culture and practice of the NHS. The critical factor is health professionals' willingness and ability to share decision-making power with patients.
The difference between informed choice and shared decision-making
Patients must have high quality information in order to share decisions, but shared decision-making is more than 'informed choice'.
In the informed choice model, patients are regarded as consumers who make choices based on the factual information that health professionals (or others, such as regulators) provide. The system is responsible for providing information, patients are responsible for the decisions they make based on that information.
Shared decision-making uses two equal but different sources of information and expertise:
- the health professional as an expert on health conditions and on the clinical evidence base - the effectiveness, probable benefits and potential harms of treatment options
- the patient as an expert on herself, how the condition specifically affects her, her social circumstances, her attitudes to illness and risk, her values and preferences with regard to potential benefits and outcomes, and the trade-offs she is prepared to make.
Both parties share responsibility for providing information, making the decision and managing care and treatment in line with that decision.