Prominent strategy but rare in practice: shared decision-making and patient decision support technologies in the UK.

In the UK there has recently been considerable financial investment in the publicly funded health service, NHS, but it is unclear whether this has resulted in improvements in patient participation and shared decision-making. There has been encouragement from central government in the form of initiatives such as copying referral letters. Progress, however, has been slow, and the quality of materials, for example, available to patients is highly variable. Nonetheless, there are other organisations, outside of central government, which are active in this field. The Picker Institute, for example, is involved in research, policy and the development of initiatives to improve patient participation. Two of the most important arenas for shared decision-making implementation in the UK are education and the development of patient decision support technologies (PDSTs). In the case of medical education, whilst there has been some recognition at policy level, implementation, to date, has been limited across both undergraduate and postgraduate curricula. Similarly, the development of PDSTs has been unplanned and fragmented, though is gaining momentum in a number of clinical domains. In terms of barriers and support for shared decision-making implementation in the UK, attention has been focused on the role of financial incentives for healthcare organisations, and on the role of Information Technology, specifically the potential benefits to patients of the 3.3 euro National Programme for IT. The legislative framework in the UK is conducive to the implementation of shared decision-making, and there is a growing body of research literature, albeit focused on PDSTs.