Shared decision making is a collaborative process that involves a person and their healthcare professional working together to reach a joint decision about care. It could be care the person needs straightaway or care in the future, for example, through advance care planning. It involves choosing tests and treatments based both on evidence and on the person's individual preferences, beliefs and values. It means making sure the person understands the risks, benefits and possible consequences of different options through discussion and information sharing. This joint process empowers people to make decisions about the care that is right for them at that time (with the options of choosing to have no treatment or not changing what they are currently doing always included). In line with NHS England's personalised care and support planning guidance: guidance for local maternity systems, in maternity services this may be referred to as 'informed decision making'.
Shared decision making is enshrined as a principle in the NHS Constitution, with principle 4 stating that, 'Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment'.
Some people prefer not to take an active role in making decisions with their healthcare professionals, but they should always be given the opportunity to choose to what degree they want to engage in decision making and the extent to which decisions that are made on their behalf are discussed and communicated with them, including the reasons for selecting a particular treatment. Involving people in decisions about their care may result in:
greater satisfaction with the decisions made
greater understanding about the risks and benefits of the available options
better communication between people and their healthcare professional, including people feeling that they have 'been heard'
improved trust between people and their healthcare professional
better concordance with an agreed treatment plan
people reporting a better experience of care, including more satisfaction with the outcome.
After the Montgomery v Lanarkshire case (2015), a new legal standard was set to protect people's rights to make informed decisions when giving or withholding consent to treatment. Healthcare professionals should discuss the risks and benefits of each course of action that are meaningful to the particular person. Consent 'must be obtained before treatment interfering with bodily integrity is undertaken', and it should only be gained when a person has shared a decision informed by what is known about the risks, benefits and consequences of all reasonable NHS treatment options. As set out in the NHS Constitution for England, people have the right to be involved in planning and making decisions about their health and care, and to be given information and support to enable this.
The General Medical Council's guidance on decision making and consent (published in 2020) says that healthcare professionals should discuss 'risks of harm and potential benefits that the patient would consider significant for any reason. These will be revealed during your discussion with the patient about what matters to them'. It also states that they should discuss 'any risk of serious harm, however unlikely it is to occur'.