European Experience with Shared Decision Making

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Angela Coulter
Martin Härter Härter
Nora Moumjid-Ferdjaoui
Lilisbeth Perestelo-Perez
Trudy van der Weijden


 Background: Shared decision making (SDM) is frequently advocated but not yet widely implemented in European countries. Experience suggests that various incentives must be in alignment to encourage wider uptake.  Objectives: To assess readiness for mainstream implementation of SDM in five European countries. Methods: Qualitative assessment of clinical policies and the availability of various SDM support services in Germany, France, Spain, the Netherlands and the UK. Results: All five countries have research groups working on SDM, patient groups calling for its wider use, and ethical and professional standards indicating its desirability, but apart from a small number of demonstration projects, there is no evidence of a systematic approach to implementation in any of the countries as yet.  Conclusions: Greater attention will need to be given to the provision of effective leadership, training and practical support if SDM is to become a regular feature of clinical practice in these countries.  

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. Salzburg Global Seminar. Salzburg statement on shared decision making. BMJ. 2011;342.

. Stacey D, Legare F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014;1:CD001431.

. Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database of Systematic Reviews. 2015(Issue 1):Art. No. CD010523.

. Coulter A, Collins A. Making shared decision-making a reality. London: King's Fund, 2011.

. Stiggelbout AM, van der Weijden T, Wit MP, Frosch D, Legare F, Montori VM, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ. 2012;344:e256.

. Legare F, Stacey D, Turcotte S, Cossi MJ, Kryworuchko J, Graham ID, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2014;9:CD006732.

. Barry MJ, Edgman-Levitan S. Shared decision making--pinnacle of patient-centered care. The New England journal of medicine. 2012;366(9):780-1.

. Zeitschrift fur Evidenz: Fortbildung und Qualitat im Gesundheitswesen. 2007;101(4):S.201-82.

. Zeitschrift fur Evidenz: Fortbildung und Qualitat im Gesundheitswesen. 2011;105(4):S.227-326.

. Härter M, Müller H, Dirmaier J, Donner-Banzhoff N, Bieber C, Eich W. Patient participation and shared decision making in Germany - history, agents and current transfer to practice. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. 2011;105(4):263-70.

. Durif-Bruckert C, Roux P, Morelle M, Mignotte H, Faure C, Moumjid-Ferdjaoui N. Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation. European Journal of Cancer Care (Engl). 2014. doi:10.1111/ecc.12214.

. De Las Cuevas C, Perestelo-Perez L, Rivero-Santana A, Cebolla-Marti A, Scholl I, Harter M. Validation of the Spanish version of the 9-item Shared Decision-Making Questionnaire. Health Expectations : an international journal of public participation in health care and health policy. 5 Mar 2014. doi:10.1111/hex.12183.

. Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ. Shared decision making in chronic care in the context of evidence based practice in nursing. International Journal of Nursing Studies. 2015;52(1):393-402.

. World Health Organisation. A declaration on the promotion of patients' rights in Europe: European consultation on the rights of patients. Copenhagen: WHO Europe, 1994.

. National Voices. Share the power: National Voices; 2011. Available from:

. Moulton B, Collins PA, Burns-Cox N, Coulter A. From informed consent to informed request: Do we need a new gold standard? Journal of the Royal Society of Medicine. 2013;106(10):391-4.

. General Medical Council. Consent: patients and doctors making decisions together. London: General Medical Council, 2008.

. Legare F, Moumjid-Ferdjaoui N, Drolet R, Stacey D, Härter M, Bastian H, et al. Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group. J Contin Educ Health Prof. 2013;33(4):267-73.

. Bieber C, Nicolai J, Hartmann M, Blumenstiel K, Ringel N, Schneider A, et al. Training physicians in shared decision-making-who can be reached and what is achieved? Patient Education and Counseling. 2009;77(1):48-54.

. Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R. Implementing shared decision making in the NHS. BMJ. 2010;341:c5146.

. Coulter A, Stilwell D, Kryworuchko J, Mullen PD, Ng CJ, van der Weijden T. A systematic development process for patient decision aids. BMC Medical Informatics and Decision Making. 2013;13 Suppl 2:S2.

. Agoritsas T, Heen AF, Brandt L, Alonso-Coello P, Kristiansen A, Akl EA, et al. Decision aids that really promote shared decision making: the pace quickens. BMJ. 2015; 350: g7624.

. Elwyn G, O'Connor AM, Bennett C, Newcombe RG, Politi M, Durand MA, et al. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS One. 2009;4(3):e4705.

. Joseph-Williams N, Newcombe R, Politi M, Durand MA, Sivell S, Stacey D, et al. Toward Minimum Standards for Certifying Patient Decision Aids: A Modified Delphi Consensus Process. Medical Decision Making : An International Journal of the Society for Medical Decision Making. 2013;34(6):699-710.

. Barr PJ, Thompson R, Walsh T, Grande SW, Ozanne EM, Elwyn G. The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process. J Med Internet Res. 2014;16(1):e2.

. Scholl I, Koelewijn-van Loon M, Sepucha K, Elwyn G, Legare F, Härter M, et al. Measurement of shared decision making - a review of instruments. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. 2011;105(4):313-24.

. Scholl I, Nicolai J, Pahlke S, Kriston L, Krupat E, Harter M. The German version of the Four Habits Coding Scheme - association between physicians' communication and shared decision making skills in the medical encounter. Patient Education and Counseling. 2014;94(2):224-9.