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Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)
Abstract
Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.
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“The shared decision making model suggests that HCPs can facilitate shared decisions by presenting treatment options, outlining the benefits and risks, and helping patients/caregivers to evaluate these options against their own goals and preferences.[36–37]”
From Perceived healthcare provider reactions to patient and caregiver use of online health communities (2014) · cites this paper as [37]
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“Most importantly, patients should be given sufficient information about the medication and be part of the decision making process (63).”
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The Connection Between Evidence-Based Medicine and Shared Decision Making
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“In other models, the process is left to the discretion of the individual patient and clinician.(7,8,17,18) Of those models that define specific steps, many acknowledge the patient’s right to relinquish the decision to the clinician and proceed in a paternalistic model, several call for evidence-based presentations of…”
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“Initial item formulations were based on core aspects of the principles of shared decision making [44,45,47,48], and on a detailed analysis of existing measurement challenges [1].”
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“No other uses without permission advantage of both parties’ expertise [22,23].”
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“It has further been recommended to be used whenever various treatment options exist (Charles et al., 1997).”
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“The past two decades of psychosocial oncology research have seen increasing emphasis on the values of patient autonomy and shared decision making (Balint and Shelton, 1996; Charles et al., 1997; Quill and Brody, 1996).”
BackgroundBarriers and facilitators of pediatric shared decision-making: a systematic review
Boland, L., Graham, I. D., Légaré, F., Lewis, K. B., Jull, J., Shephard, A., Lawson, M. L., Davis, A., Yameogo, A., & Stacey, D. (2019) · Implementation Science · doi:10.1186/s13012-018-0851-5 · Cited by 383
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“This is in contrast with the promotion of a specific course of action seen with directive counseling or the abdication of involvement in the decision-making process that is inherent in the informed choice model.(54) In the contraceptive context, this approach would allow for both the focus on patient preferences and r…”
BackgroundShared decision making: what do clinicians need to know and why should they bother?
Hoffmann, T., Légaré, F., Simmons, M. B., Namara, K. M., McCaffery, K. J., Trevena, L. J., Hudson, B., Glasziou, P., & Mar, C. D. (2014) · The Medical Journal of Australia · doi:10.5694/mja14.00002 · Cited by 343
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Shared Decision Making in Health Care
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“It is now 12 years since the seminal paper by Charles et al. (1997) and 8 years since the first International Shared Decision Making Conference in Oxford, UK, and the first edition of this volume (Edwards and Elwyn, 2001).”
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“Efforts to improve tailored interactions with patients present a number of challenges, including that this is a labor-intensive endeavor ( Charles, Gafni, and Whelan 1997 ).”
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“We included articles published between January 1997, the year in which Charles and colleagues described the concept of SDM in their seminal article [28], and October 10, 2016.”
MethodCOVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic
Shaker, M. S., Oppenheimer, J. J., Grayson, M. H., Stukus, D. R., Hartog, N., Hsieh, E. W. Y., Rider, N. I., Dutmer, C. M., Leek, T. K. V., Kim, H. L., et al. (2020) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2020.03.012 · Cited by 332
“64, 65 Please see this article's Online Repository at www.jaci-inpractice.org for additional information on shared decision making during the pandemic.”
When the treatment goal is not cure: are cancer patients equipped to make informed decisions?
Gattellari, M., Voigt, K. J., Butow, P. N., & Tattersall, M. H. N. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.2002.20.2.503 · Cited by 344
Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis
Wyatt, K. D., List, B. A., Brinkman, W. B., Lopez, G. P., Asi, N., Erwin, P. J., Wang, Z., Garces, J. P. D., Montori, V. M., & LeBlanc, A. (2015) · Academic Pediatrics · doi:10.1016/j.acap.2015.03.011 · Cited by 345
Interventions for improving the adoption of shared decision making by healthcare professionals
Légaré, F., Stacey, D., Turcotte, S., Cossi, M.-J., Kryworuchko, J., Graham, I. D., Lyddiatt, A., Politi, M. C., Thomson, R., Elwyn, G. J., et al. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006732.pub3 · Cited by 332
Deber, R. B., Kraetschmer, N., Urowitz, S., & Sharpe, N. (2007) · Health Expectations · doi:10.1111/j.1369-7625.2007.00441.x · Cited by 322
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Sandman, L., & Munthe, C. (2009) · Health Care Analysis · doi:10.1007/s10728-008-0108-6 · Cited by 317
“The second is to resolve conflicts of interest – where the process is often referred to as negotiation (Charles et al. 1997 & 1999, Makoul & Clayman 2006).”
BackgroundInfluentialPatient involvement in treatment decision-making: The case for a broader conceptual framework
Entwistle, V. A., & Watt, I. S. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.05.002 · Cited by 316
“[19,20].”
BackgroundVeroff, D. R., Marr, A. L., & Wennberg, D. E. (2013) · Health Affairs · doi:10.1377/hlthaff.2011.0941 · Cited by 323
Scholl, I., Kriston, L., Dirmaier, J., Buchholz, A., & Härter, M. C. (2012) · Patient Education and Counseling · doi:10.1016/j.pec.2012.03.005 · Cited by 307
“[3], it is important to take into account the dynamics of this interaction between the patient and the clinician.”
BackgroundShared decision making in psychiatry
Hamann, J., Leucht, S., & Kissling, W. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2003.00130.x · Cited by 306
“Such a decision aid should present all available therapy options for the respective treatment situation in an objective manner and be easily comprehensible to the patients (3).”
BackgroundInfluentialJanz, N. K., Wren, P. A., Copeland, L. A., Lowery, J. C., Goldfarb, S. L., & Wilkins, E. G. (2004) · Journal of Clinical Oncology · doi:10.1200/jco.2004.09.069 · Cited by 303
“arrive at a consensus regarding the preferred treatment option.(4) Some research-”
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Shared Decision-Making and Evidence-Based Practice
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“Clients, on the other hand, are the experts on their own values, treatment preferences, and treatment goals ( Charles, Gafni, & Whelan, 1997 ).”
BackgroundInternational Journal of Collaborative Research on Internal Medicine & Public Health
Valdivia, J. R. M. (2021) · Journal of Womens Health Issues and Care · Cited by 300
Elwyn, G. J., Edwards, A., Gwyn, R., & Grol, R. P. T. M. (1999) · BMJ · doi:10.1136/bmj.319.7212.753 · Cited by 299
“A paternalistic approach involves taking the responsibility for decision making. Informed choice is at the opposite end of the spectrum, where the patient is provided with “sufficient” information and the clinician withdraws from the decision process. Shared decision making describes the middle ground.”
BackgroundShared decision making for in‐patients with schizophrenia
Hamann, J., Langer, B., Winkler, V., Busch, R., Cohen, R., Leucht, S., & Kissling, W. (2006) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2006.00798.x · Cited by 296
“Most authors classify SDM somewhere between the so-called traditional medical and the informed choice model (4, 5).”
BackgroundTraining health professionals in shared decision-making: An international environmental scan
Légaré, F., Politi, M. C., Drolet, R., Desroches, S., Stacey, D., & Bekker, H. (2012) · Patient Education and Counseling · doi:10.1016/j.pec.2012.01.002 · Cited by 288
The Patient-Physician Relationship in the Internet Age: Future Prospects and the Research Agenda
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“Shared decision-making includes the ideal that both parties need to agree on a treatment option, even if both do not agree that it is the best possible treatment to implement [14].”
BackgroundInfluentialEdwards, A., & Elwyn, G. J. (2006) · Health Expectations · doi:10.1111/j.1369-7625.2006.00401.x · Cited by 290
Improving patient adherence: a three-factor model to guide practice
DiMatteo, M. R., Haskard-Zolnierek, K. B., & Martin, L. R. (2012) · Health Psychology Review · doi:10.1080/17437199.2010.537592 · Cited by 288
“Shared decision-making involves a two-way exchange of information between healthcare professional and patient, addressing all information (including psychosocial) that is relevant to the decision (Charles, Gafni, & Whelan, 1997 ).”
Women’s preferences for contraceptive counseling and decision making
Dehlendorf, C., Levy, K., Kelley, A., Grumbach, K., & Steinauer, J. (2012) · Contraception · doi:10.1016/j.contraception.2012.10.012 · Cited by 293
“[23], which divides the decision making process into three phases: information sharing, deliberation and decision making.”
Background
Metadata
- Authors
- Charles, C., Gafni, A., & Whelan, T.
- Affiliations
- McMaster University (CA)
- Corresponding author
- Charles, Cathy
- ORCID
- Gafni, Amiram
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1997-03
- Volume
- 44
- Issue
- 5
- Pages
- 681-692
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2040607890
- Cited by
- 4,137
- References
- 68
- Citations by year
- 2026: 168 · 2025: 200 · 2024: 224 · 2023: 213 · 2022: 174 · 2021: 247 · 2020: 250 · 2019: 233 · 2018: 224 · 2017: 234 · 2016: 209 · 2015: 182 · 2014: 221 · 2013: 192 · 2012: 187
- FWCI
- 63.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- shared decision-making, physician-patient relationship, treatment decision-making, shared information, consensus building, patient involvement in care
- MeSH terms
- Decision Making, Humans, Informed Consent, Models, Psychological, Patient Participation, Physician-Patient Relations, Patient Satisfaction
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