Shared decision making in Spain: Supportive policies and research initiatives, trends and directions for future.

Patients' rights to autonomy, information and participation in their own health care are recognized in the Spanish legal system from the early 2000's. Public institutions have progressively launched several initiatives to promote and improve patients' empowerment and self-care. However, the concept of shared decision making (SDM), although embedded in the more general concept of "active/empowered patient", usually has not been specifically advocated as an essential requisite for improving the quality of health services, either in the legal normative or the existing educational proposals. Research on SDM and the development of Patient Decision Aids (PtDAs) has increasingly grown and currently there are several of these materials available for patients with different diseases. Along with this research activity, the growing interest of patients and professionals in patient participation and SDM makes us optimistic about a gradual development of this care model in the medium term. However, there are several limitations and challenges that must be overcome in the near future. The implementation of PtDAs in clinical practice is imperative and issues such as their inclusion in clinical guidelines and electronic medical records should be encouraged. Concurrently, it is necessary to train professionals in SDM skills and the use of encounter PtDAs.