| Verified against primary record | |
| Reference definition | A collaborative process in which a person and their clinician reach a joint decision, selecting tests and treatments on both evidence and the person’s values, with no treatment always an option[1] |
|---|---|
| Stated exclusions | Unexpected emergencies requiring immediate life-saving care, and situations where an adult lacks capacity at the time of the decision[2] |
| Risk communication requirements | Absolute rather than relative risk, natural frequencies rather than percentages, consistent denominators, stated time periods, both framings, and explicit uncertainty[1] |
| Independently reported | |
| In medical travel | No study, standard or accreditation requirement documenting the practice in a cross-border setting was located[3] |
| Bands apply only to the rows beneath them. The final row records the result of a search; the literature that does exist describes decision-making shifted onto the patient rather than shared. | |
Shared decision-making is a process in which a patient and a clinician reach a treatment decision together, weighing the evidence against what matters to the patient. In treatment travel the clinician half of that pairing is frequently missing, and the published literature describes the decision burden moving to the patient rather than being shared.
The reference definition and what it requires
The English national guideline defines shared decision-making as a collaborative process involving a person and their healthcare professional working together to reach a joint decision about care, selecting tests and treatments on the basis of both evidence and the person’s values and preferences, with no treatment always among the options. It sets requirements at four levels: organisational embedding, with senior leadership accountability, champions, an improvement plan and staff training; putting it into practice, with support before, during and after discussions, agenda setting, checks that the person has understood, clear documentation and written summaries; patient decision aids; and the communication of risks, benefits and consequences. On decision aids it is specific that they are part of a wider toolkit rather than a substitute for the consultation, that only quality-assured aids relevant to the decision and setting should be used, and that aids describe options and help people weigh them without recommending one. On risk it requires absolute rather than relative risk, natural frequencies such as 10 in 100 rather than percentages, consistent denominators, stated time periods, both positive and negative framing, and explicit acknowledgement of uncertainty.[1]
The guideline is not universal in its own terms. It applies to everyday care in all healthcare settings but excludes unexpected emergencies needing immediate life-saving care, and situations where an adult lacks mental capacity at the time of the decision, which are covered separately.[2] The health service that commissions to it does not advance a definition of its own, adopting both the guideline formulation and an earlier policy one, and notes that the process covers care needed straight away and care in the future, with choosing no treatment or continuing current care always an option.[4]
Process models and evidence
The most cited process model divides the consultation into three conversations: team talk, supporting patients as they first learn their options and eliciting their goals to guide the decision; option talk, comparing alternatives using risk-communication principles; and decision talk, reaching a decision that reflects informed preferences alongside the clinician’s expertise. The model was revised through a multistage consultation with 19 key informants, 153 stakeholder responses and 316 clinician survey responses across six specialties, which changed one category, added the elicitation of patient goals, defined tasks for each category and added suggested scripts.[5]
A federal American framing describes the process in compatible terms, as one in which clinicians and patients use evidence-based information to explore and compare the benefits, harms and risks of each option, working through dialogue about what matters most to the patient to reach a decision together.[6] The evidence base for decision aids is large: a systematic review covering 209 studies and 107,698 participants reports benefit over usual care across decisions ranging from cancer screening to major elective surgery.[7] Specific effect sizes are not reproduced here, because the summary consulted does not report them.
What happens instead in treatment travel
No study, standard or accreditation requirement documenting shared decision-making as practised in a medical travel setting was located, and no decision aid validated for cross-border decisions. What the literature records is the inverse. Focus groups with 22 family physicians in one Canadian province found that medical travel can weaken the shared decision-making that normally involves the regular family physician, who may be unfamiliar with the options abroad; that the physicians felt unprepared to assess overseas providers and procedures, which shifted the burden of finding and evaluating information onto the patient; and the authors conclude that medical travellers carry a greater share of health-related decision-making than patients who remain within their home system.[3]
A second study identifies inadequate communication of risks and failure to achieve informed consent as patient-health concerns in medical travel, with barriers including language differences, time pressure in the process and the financial interests of facilities; it records that the ethical and safety concerns are not discussed in the information sources commonly provided to medical travellers, most of which come from parties with a financial interest, and that the authors’ own response was an information sheet intended to inform rather than persuade, whose effectiveness they state is unclear.[8]
Both studies are Canadian and a decade or more old, and the gap in the literature is itself unquantified. The structural point survives the limitation: the guideline’s requirements assume a clinician with no financial interest in the chosen option, access to quality-assured decision aids, and time. In the standard medical travel transaction the person presenting the options is the party that will be paid for performing them.
See also
- Second Medical Opinions, the mechanism designed to supply an adviser with no stake in the answer
- Medical Tourism and Health Literacy, on what the patient is assumed to be able to read and weigh
- Medical Tourism Facilitators, the intermediaries whose material the decision is often based on
- Medical Travel and Language Barriers, one of the named obstacles to informed consent abroad
References
- National Institute for Health and Care Excellence. Shared decision making, NG197. Published 17 June 2021, minor update October 2021. Verified against primary record: the full guideline PDF was opened and the definition, the four recommendation areas, the decision-aid provisions and the risk-communication requirements read. Retrieved 10 October 2026.
- National Institute for Health and Care Excellence. Shared decision making, NG197: overview. Last reviewed 17 June 2021. Verified against primary record: the overview was opened and the scope and the stated exclusions read. Retrieved 10 October 2026.
- Snyder J, Crooks VA, Johnston R, Dharamsi S. The challenges that medical tourism poses to Canadian family physicians’ support of patients’ informed decision-making. BMC Medical Ethics 2013;14:37, 22 September 2013. Verified against primary record: the article was opened and the focus-group findings and the authors’ conclusion read. Note the scope limit: physician perspectives only, one Canadian province, 2013. Retrieved 10 October 2026.
- NHS England. About shared decision making. No page date; cites a 2019 policy document and the 2021 guideline. Verified against primary record: the page was opened and the two adopted definitions read. Retrieved 10 October 2026.
- Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, Cochran N, Frosch D, Galasinski D, Gulbrandsen P, Han PKJ, Harter M, Kinnersley P, Lloyd A, Mishra M, Perestelo-Perez L, Scholl I, Tomori K, Trevena L, Witteman HO, Van der Weijden T. A three-talk model for shared decision making: multistage consultation process. BMJ 2017;359:j4891, 6 November 2017. Verified against primary record: the repository record and the published version were opened and the three categories and the revision method read. Retrieved 10 October 2026.
- Agency for Healthcare Research and Quality. The SHARE Approach: shared decisionmaking tools and training. Publication date April 2014; last reviewed February 2025. Verified against primary record: the page was opened and its description of the process read. The five steps are not listed on this page and are not reproduced here. Retrieved 10 October 2026.
- Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Legare F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2024, Issue 1, CD001431; summary dated 16 January 2024. Independently reported: the publisher’s summary was opened and the review’s scale and general finding read; the review itself was not opened, so no effect size is reported here. Retrieved 10 October 2026.
- Adams K, Snyder J, Crooks VA, Johnston R. Developing an informational tool for ethical engagement in medical tourism. Philosophy, Ethics, and Humanities in Medicine 2017;12:4, 25 August 2017. Verified against primary record: the article was opened and its account of informed-consent barriers, the provenance of information sources and the authors’ stated limitation read. Retrieved 10 October 2026.
Sourcing note: the slogan about no decision being taken without the patient is a policy phrase rather than a definition and does not appear on the current health service page, so it is not used here. An earlier English guideline’s shared decision-making recommendations were deleted in June 2021 and replaced by a pointer to the current guideline, so that earlier guideline is not cited for this subject. A stated-preference study of hypothetical travel choices was reviewed and is not cited, because its figures describe hypothetical choices by a young social-media sample rather than behaviour.