Delivery of patient centred care in routine practice requires a whole system change.

Walsh and colleagues’ systematic review found no evidence that the use of patient decision aids saves costs. The accompanying editorial by Katz concluded that there is “no compelling reason to prioritise research on the potential role of patient decision support in reducing budgets.” We agree that these areas should not be a top priority for research into patient decision aids. However, Katz erroneously identified several research questions that have already been resolved as still unanswered. 4 We welcome the renewed focus on patient decision aids. However, use of these aids is only one component of the transformational change needed to promote and embed patient centred care into usual clinical practice. These aids are not aimed just at saving treatment costs, but can also help change the relationship between clinicians and patients, particularly in the management of long term conditions. The routine use of patient decision aids as part of “whole system” change can also facilitate the introduction of other patient centred care initiatives, such as shared decision making, support for self management, and care planning. We believe that the evaluation of patient decision aids to save money should be secondary to the development of effective and efficient patient-clinician partnerships. Surely the goal should be for clinicians to discuss the evidence for the available treatment choices with informed patients as part of a strategy to help them adapt and self manage their condition. However, the delivery of patient centred care in routine clinical practice cannot be achieved without a whole system change. The recently created Coalition for Collaborative Care (www. coalitionforcollaborativecare.org.uk) aims to promote such a change in the delivery of care to people with long term conditions in general practice.