'It's Got to Be the Patient's Decision': Practicing Shared Decision-making in the U.K. Renal Units

In modern medicine, patient choice and involvement in treatment decision-making are increasingly recognised as an important issue in improving the quality of healthcare, and in recent years the concept of shared decision-making has attracted attention as a new approach in the medical encounter. This model is particularly appropriate in life-threatening situations in which no best treatment exists and there are trade-offs between benefits and risk of available treatments. In this article, I demonstrate how clinical uncertainty makes shared decision-making difficult in practice, using the case of elderly patients with end-stage renal failure based on data collected by interviewing renal healthcare professionals in the U.K. I then propose the possibility of 'patient choice' becoming a burden for some elderly patients and the institutionalisation of shared decision-making, and discuss the importance of building a good relationship between healthcare professionals and patients to facilitate shared decision-making.