Background: Shared decision making (SDM) is frequently advocated but not yet widely implemented in European countries. Experience suggests that various incentives must be in alignment to encourage wider uptake. Objectives: To assess readiness for mainstream implementation of SDM in five European countries. Methods: Qualitative assessment of clinical policies and the availability of various SDM support services in Germany, France, Spain, the Netherlands and the UK. Results: All five countries have research groups working on SDM, patient groups calling for its wider use, and ethical and professional standards indicating its desirability, but apart from a small number of demonstration projects, there is no evidence of a systematic approach to implementation in any of the countries as yet. Conclusions: Greater attention will need to be given to the provision of effective leadership, training and practical support if SDM is to become a regular feature of clinical practice in these countries.