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approaches engender a sense of ownership of the process and are consistent with educational theory. 16owever, although these training programmes may help professionals to assimilate the philosophy and skills required for involving patients more in decision making, more is still required.Clearly, professionals need to engage with such training and this is not automatic.Motivation for participation in the training is achieved in some healthcare systems by financial incentives or the requirements of revalidation or re-certification.However, a further stimulus should not be neglected-namely, the expectations of patients and patient advocate groups.At present, in the UK at least, a substantial proportion of consumers do not apparently wish to be involved in making choices about their treatment or care, 17 but evidence is also accruing about the benefits of involvement and decision support. 3There is therefore justification for continued pressure on professionals from patient advocate groups to promote and expect newer consulting approaches.This may prove to be the most crucial influence.At a wider level, it may also be a case study in making explicit the links between patient expectations, professional development requirements, and training programmes.It may provide a model in which professionals identify their needs for continuing professional development directly from the needs of patients and seek new training opportunities.
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N Barber (2001) studied this question.
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