The Salzburg Statement on Shared Decision Making

This Thursday at the headquarters of the British Medical Journal in London, an important announcement will be made about patients’ rights to be actively involved in decisions about their treatment. Below is the press release about it.

The subject is shared decision making, which we’ve been posting about recently (series here; initial post here.) Developed by the participants in a Salzburg Global Seminar last December, the document is called the Salzburg Statement. The pivotal distinction here is the difference between informed consent, in which the physician assesses the options and selects one, and gets your consent to do it; and informed choice, in which clinicians tell you the options, with all the pros and cons, and let you choose, based on your preferences.

Click the image to download. (It’s an A4 PDF; to print, those using letter size paper should select “Page Scaling: Fit.”)

Here’s today’s press release:

Patients and clinicians must share healthcare decisions, say experts

Clinicians have an ethical imperative to share important decisions with patients, and patients have a right to be equal participants in their care, say a group of experts today.

In December 2010, 58 people from 18 countries attended a Salzburg Global Seminar to consider the role patients can and should play in healthcare decisions. Today, they publish a statement urging patients and clinicians “to work together to be co-producers of health.”

It comes as the government in England finalises plans to give people more say and more choice over their care than ever before.

The experts argue that much of the care patients receive is based on the ability and readiness of individual clinicians to provide it, rather than on widely agreed standards of best practice or patients’ preferences for treatment.

Results from the 2010 Cancer Patient Experience Survey seem to support this view. It found significant variations in the choice and information patients are given, and their involvement in decisions about treatment.

The experts also say that clinicians are often slow to recognise the extent to which patients’ wish to be involved in understanding their health problems, in knowing the options available to them, and in making decisions that take account of their personal preferences.

As such they call on clinicians to stimulate a two-way flow of information with patients, to provide accurate information about treatment, to tailor information to individual patient needs and allow them sufficient time to consider their options. In turn, they urge patients to ask questions and speak up about their concerns, to recognise that they have a right to be equal participants in their care, and to seek and use high-quality health information.

They also call on policymakers to adopt policies that encourage shared decision making and to support the development of skills and tools for shared decision making.

One of the signatories, Professor Glyn Elwyn from Cardiff University, says that despite considerable interest in shared decision making, and clear evidence of benefit, implementation within the NHS “has proved difficult and slow.”

Angela Coulter from the Foundation for Informed Medical Decision Making agrees and points to recent evidence showing that most patients want choice, but that many clinicians remain ambivalent or antagonistic to the idea. She believes the government’s new commitment to shared decision making presents a challenge to entrenched attitudes and the need for big change in practice styles.

The BMJ is hosting an expert roundtable event to discuss shared decision making at 3pm on Thursday 24 March 2011. Following the roundtable, at 5.30pm Muir Gray and Gerd Gigerenzer will be launching their book: “Better doctors, better patients, better decisions: Envisioning health care 2020.”

Any journalists wishing to attend these events, please contact Emma Dickinson on +44 (0)20 7383 6529, Email:

Professor Glyn Elwyn, Department of Primary Care and Public Health, Cardiff University, Cardiff, Wales
Tel: + 44 (0)29 20 68 71 95

Click here to view the full statement:
Click here to view more details about the Salzburg Global Seminar:


Posted in: general | pt/doc co-care | reforming hc | shared decision making | trends & principles




6 Responses to “The Salzburg Statement on Shared Decision Making”

  1. […] The Salzburg Statement on Shared Decision Making | – Nice summary by @epatientdave about the Salzburg statement, changing the conversation from “informed consent” to “informed choice.” If you read the post, you’ll see that they’ve though of things in the context of current medical practice and have a good understanding of the hurdles. […]

  2. Dave – great post and great work in helping produce the Salzberg Statement. I’ve incorporated it and this post into a lecture I’ll be giving to pharmacy students in a couple weeks.


  3. […] federales get this right?  Is it too much to ask that an ACO go 8 for 8?  What’s missing?  Is shared decisionmaking a step further than patient-centeredness, or is that something that the Society should seek to have […]

  4. Jean says:

    I think that the patient-centered shared decision making process should be informed by patient options are that are affordable and readily available to them in the community or within their care plans with family and friends. I believe that the patient should have availble to them sound information on costs, available options and sustainability in order to make sound informed decisions. I’m not sure where that support, information and weighing of options comes from in the various models that I’ve read about.

  5. […] sparked by the Salzburg Statement, a call to action by 58 experts from 18 countries. Check out the post explaining the Salzburg Statement on Shared Decision Making: “The pivotal distinction here is the difference between informed consent, in which the physician […]

  6. […] dicembre 2010, in occasione del Seminario Globale di Salisburgo, è stato pubblicato il “Salzburg statement on shared decision making” che elenca una serie di azioni che medici e pazienti dovrebbero compiere insieme per rendere […]

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