The clinical management of a patient’s condition is one of many components of patient care. A key pillar is collaboration between patient and practitioner, which underpins care and empowers patients. Until recently, however, there was a lack of practical guidance on how to involve patients in decisions about their care; publication of NICE Guideline 197, Shared decision making, is therefore to be welcomed.Dr Natalie Joseph‑Williams, Dr Leigh Sanyaolu, and Professor Adrian Edwards summarise the recommendations of the new guideline, and outline how it can be incorporated into routine practice. The example of antibiotic prescribing for recurrent urinary tract infection is used to demonstrate the stages involved in conducting a shared‑decision making discussion and developing a joint strategy. See also the Guidelines summary of this guidance.

Doctor and patient discussion

Incorporate shared decision making into everyday practice

Dr Natalie Joseph-Williams, Dr Leigh Sanyaolu, and Professor Adrian Edwards

Fulfilling the requirements of the shared-decision making guideline will also facilitate the implementation of other guidelines. This overlap of objectives when implementing recommendations is evident in Dr Tom McAnea’s analysis of the recently published NICE guideline on atrial fibrillation (AF). Dr McAnea stresses the importance of reaching a shared agreement with patients, and explains how joint decisions on the use of direct acting oral anticoagulants in AF have been embedded in primary care practice.

Mutual agreements between patients and practitioners can also be made in relation to stopping current treatments, as Dr David Strain highlights in his article, which explores a consensus statement on the management of diabetes in the context of frailty. He describes the circumstances under which it may be more beneficial to de-escalate pharmacotherapy for glycaemic control—for example, if the time to benefit is insufficient to justify the potential complications or side effects. However, this could be perceived by patients as an attempt at rationing or cost-cutting, or as a sign that there is no longer any hope for them. Dr Strain emphasises the importance of involving the patient in this discussion and developing strategies in collaboration.

In this month’s expert article, Jane Scullion provides top tips on diagnosing and managing asthma in adults. She details how to recognise the risk factors, triggers, and phenotypes of asthma, describes the tools available for assessment and diagnosis, and provides information on interventions and pharmacological treatments.

Finally, in this issue’s View from the ground, Dr Claire Davies provides a timely reminder of the wider determinants of health in a thought-provoking look at the impact of housing on patients’ lives. Dr Davies also underlines the all‑encompassing role that GPs sometimes play in patients’ lives; perhaps some patients might benefit from the extension of shared decision making into other, non-clinical, spheres of life.

Other things to look out for include: 


1. NICE. Shared decision making. NICE Guideline 197. NICE, 2021. Available at: