Choosing wisely? A frame analysis of the evolution and adoption of shared decision making in the UK

<p dir="ltr">The UK Choosing Wisely campaign, launched in 2016, represented a spread of the US movement concerned about the proliferation of tests and procedures with limited value for patients (Santhirapala et al., 2019; Schlesinger & Grob, 2017). In the UK, where assessment of treatment value is centralised to the National Institute of Health and Care Excellence (NICE), the focus of Choosing Wisely has been on shared decision making, regarded as an essential component in the provision of personalised care (NHS England, 2019a). Shared decision making is representative of a wider global shift in healthcare from the paternalistic approach of ‘doctor knows best’ towards collaborative approaches to involve patients in decisions about their care, summed up in the phrase: ‘nothing about me without me’ (Coulter & Collins, 2011). Shared decision making emerged from concerns to foster ethical patient-practitioner relationships (Härter et al., 2011; Stiggelbout et al., 2015) as a way of evaluating and selecting courses of action jointly between patients, their family members or carers, and clinicians. Although widely accepted as representing the ‘pinnacle’ of patient-centred care (Barry & Edgman-Levitan, 2012), there remain difficulties in implementing shared decision making in all clinical encounters.</p>