Cited by 4,137Patient-Provider Communication in HealthcarePalliative Care and End-of-Life IssuesEthics and bioethics in healthcare

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Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)

Charles, Cathy, Gafni, Amiram, Whelan, Tim·1997·Social Science & Medicine

DOI 10.1016/s0277-9536(96)00221-3

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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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Background
Health Literacy and Health-Care Engagement as Predictors of Shared Decision-Making Among Adult Information Seekers in the USA: a Secondary Data Analysis of the Health Information National Trends Survey
Wigfall, L. T., & Tanner, A. H. (2016) · Journal of Cancer Education · doi:10.1007/s13187-016-1052-z · Cited by 42
“The key characteristics of SDM have been described as the following: (1) at a minimum involves patients and providers, (2) requires good patient-provider communication, such as patients being able to ask health-related questions and providers making sure that patients understand the health information shared with them…”
Influential
Shared Decision-Making in Patients With Prostate Cancer in Japan: Patient Preferences Versus Physician Perceptions
Schaede, U., Mahlich, J., Nakayama, M., Kobayashi, H., Takahashi, Y., Saito, K., Uemura, H., Tokumitsu, M., & Yoshizawa, K. (2017) · Journal of Global Oncology · doi:10.1200/jgo.2016.008045 · Cited by 39
“Several studies conducted in the United States dating back to the 1980s and 1990s showed that patients felt a need to be involved in making treatment decisions and that shared decision making (SDM) improves compliance with treatment regimens and the overall patient situation.(1-7) In spite of these insights, a seminal…”
Background
Multidisciplinary coordinated care for Type 2 diabetes: A qualitative analysis of patient perspectives
Berkowitz, S. A., Eisenstat, S. A., Barnard, L. S., & Wexler, D. J. (2018) · Primary care diabetes · doi:10.1016/j.pcd.2018.01.005 · Cited by 39
Family Planning Knowledge, Attitudes, and Practices Among Somali and Congolese Refugee Women After Resettlement to the United States
Royer, P. A., Olson, L. M., Jackson, B., Weber, L., Gawron, L. M., Sanders, J. N., & Turok, D. K. (2019) · Qualitative Health Research · doi:10.1177/1049732319861381 · Cited by 42
“Shared decision-making models, as outlined by Charles, Gafni, and Whelan (1997) describe three phases of decision-making: (a) information sharing, (b) consensus building, and (c) decision-making.”
Method
The importance of shared decision-making in the neonatal intensive care unit
Soltys, F. C., Philpott-Streiff, S. E., Fuzzell, L. N., & Politi, M. C. (2019) · Journal of Perinatology · doi:10.1038/s41372-019-0507-6 · Cited by 39
Trust and world view in shared decision making with indigenous patients: A realist synthesis
Groot, G., Waldron, T., Barreno, L., Cochran, D., & Carr, T. (2019) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13307 · Cited by 44
“Shared decision making (SDM) emphasizes equalizing power between patients and HCPs to create more equitable health care.(16) However, limited research exists to examine if and how SDM works with indigenous patient values and preferences.”
Background
Evaluating Deliberation in Pediatric Primary Care
COX, E. D., Smith, M. A., & Brown, R. (2007) · PEDIATRICS · doi:10.1542/peds.2006-2602 · Cited by 40
Willingness to Pay for Periodontal Therapy: Development and Testing of an Instrument
Matthews, D., Sci, D. P., Birch, S., Gafni, A., & DiCenso, A. (1999) · Journal of Public Health Dentistry · doi:10.1111/j.1752-7325.1999.tb03234.x · Cited by 39
Patient autonomy in dentistry: demonstrating the role for shared decision making
Benecke, M., Kasper, J., Heesen, C., Schäffler, N., & Reissmann, D. R. (2020) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-020-01317-5 · Cited by 38
“Geiger F, Liethmann K, Reitz D, Galalae R, Kasper J. Efficacy of the doktormitSDM training module in supporting shared decision making—results from a multicenter double-blind randomized controlled trial.”
BackgroundInfluential
Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making
Köther, A. K., Büdenbender, B., Grüne, B., Holbach, S., Huber, J. C., von Landenberg, N., Lenk, J. D., Martini, T., Michel, M. S., KRIEGMAIR, M. C., et al. (2022) · Cancer Medicine · doi:10.1002/cam4.4667 · Cited by 38
“27 On these original API case vignettes, patients indicate nine different decisions (three for each vignette) who should make the corresponding decision on a 5point Likert scale ranging from (1) “The physician alone” to (5) “The patient alone.”
BackgroundInfluential
Digital Transformation in Healthcare: Insights on Value Creation
Ghosh, K., Dohan, M. S., Veldandi, H., & Garfield, M. J. (2022) · Journal of Computer Information Systems · doi:10.1080/08874417.2022.2070798 · Cited by 53
“Shared decision making entails the reaching of a consensus between physician, patient, and other decision makers such as family, for a plan of treatment.(38) This is seen as an approach that respects patient autonomy and the right to informed consent.”
Background
Shared decision making and advance care planning: a systematic literature review and novel decision-making model
Rosca, A., Karzig-Roduner, I., Kasper, J., Rogger, N., Drewniak, D., & Krones, T. (2023) · BMC Medical Ethics · doi:10.1186/s12910-023-00944-7 · Cited by 40
“SDM is a two-way information process between HCPs and patients, sharing medical and risk information as well as preferences and concerns to reach the best individual decision by negotiation [8, 9].”
Background
The ethics of influencing clients
Yeates, J. W., & Main, D. C. J. (2010) · Journal of the American Veterinary Medical Association · doi:10.2460/javma.237.3.263 · Cited by 38
Shared decision making in the recovery of people with schizophrenia: The role of metacognitive capacities in insight and pragmatic language use
Chan, K. K. S., & Mak, W. W. S. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.06.001 · Cited by 39
Shared Decision‐Making in the Selection of Outpatient Analgesics for Older Individuals in the Emergency Department
Isaacs, C. G., Kistler, C. E., Hunold, K. M., Pereira, G. F., Buchbinder, M. H., Weaver, M. A., McLean, S. A., & Platts‐Mills, T. F. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12207 · Cited by 38
Measuring patient and physician participation in exchanges on medications: Dialogue Ratio, Preponderance of Initiative, and Dialogical Roles
Richard, C., & Lussier, M. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.08.014 · Cited by 38
“Because participation is valued in contemporary models of doctor–patient communication [36–40], and has been shown to be associated with better clinical outcomes [17–21], a numerical value was attributed to each role, the lower values (0 and 1) corresponding to monologues or absence of sharing and the higher values (2…”
Background
Effectiveness of the head CT choice decision aid in parents of children with minor head trauma: study protocol for a multicenter randomized trial
Hess, E. P., Wyatt, K. D., Kharbanda, A. B., Louie, J. P., Dayan, P. S., Tzimenatos, L. S., Wootton‐Gorges, S. L., Homme, J. L., Pencille, L. J., LeBlanc, A., et al. (2014) · Trials · doi:10.1186/1745-6215-15-253 · Cited by 38
“Shared decision-making (SDM) is a process of decisionmaking in medicine that has several key features: the involvement of the patient (or parent, in a child’s case) and the clinician, a sharing of information by both parties, and both parties taking steps to reach an agreement about which management option to implemen…”
Shared Decision Making in mental health care using Routine Outcome Monitoring as a source of information: a cluster randomised controlled trial
Metz, M. J., Franx, G. C., Veerbeek, M., de Beurs, E., Feltz-Cornelis, C. M. V. D., & Beekman, A. T. F. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0696-2 · Cited by 37
“They select together the best suitable option which is consistent with patients’ values and preferences [2, 4, 5].”
Health and the Good Society
Cribb, A. (2005) · doi:10.1093/0199242739.001.0001 · Cited by 38
Should Providers Discuss Breastfeeding With Women Living With HIV in High-Income Countries? An Ethical Analysis
Johnson, G. J., Levison, J. E., & Malek, J. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw587 · Cited by 38
Does shared decision making results in better health related outcomes for individuals with painful musculoskeletal disorders? A systematic review
Tousignant‐Laflamme, Y., Christopher, S. M., Clewley, D. J., Ledbetter, L., Cook, C. J., & Cook, C. E. (2017) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2017.1323607 · Cited by 36
“At present, there are a number of SDM theories that have been developed around physician-patients interactions [4].”
Background
A perspective on nonadherence to drug therapy: psychological barriers and strategies to overcome nonadherence
Martin, L. R., Feig, C., Maksoudian, C. R., Wysong, K. E., & Faasse, K. (2018) · Patient Preference and Adherence · doi:10.2147/ppa.s155971 · Cited by 41
Interventions to support shared decision making for medication therapy in long term conditions: A systematic review
Mathijssen, E. G. E., van den Bemt, B. J. F., van den Hoogen, F. H. J., Popa, C. D., & Vriezekolk, J. E. (2019) · Patient Education and Counseling · doi:10.1016/j.pec.2019.08.034 · Cited by 39
Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study
Huang, H., Tsai, J., Yao, C., Cheng, S., Hu, W., & Chiu, T. (2020) · BMC Palliative Care · doi:10.1186/s12904-020-0521-7 · Cited by 38
The effect of pharmacist education on asthma treatment plans for simulated patients
Dolovich, L. R., Sabharwal, M., Agro, K., Foster, G., Lee, A., McCarthy, L. M., & Willan, A. R. (2007) · Pharmacy World & Science · doi:10.1007/s11096-006-9080-0 · Cited by 38
“Improved communication is an important contributing factor to establish and maintain a successful clinician– patient interaction [24–28].”
Background
What does ‘patient‐centred’ mean in relation to the consultation?
Illingworth, R. (2010) · The Clinical Teacher · doi:10.1111/j.1743-498x.2010.00367.x · Cited by 39
A conceptual model of the role of communication in surrogate decision making for hospitalized adults
Torke, A. M., Petronio, S., Sachs, G. A., Helft, P. R., & Purnell, C. E. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.07.027 · Cited by 42
“It includes mutual participation of the patient and clinician, adequate sharing of information in order to achieve informed consent and a final decision that is mutually endorsed [68].”
Background
The vexing problem of defining the meaning, role and measurement of values in treatment decision-making
Charles, C. A., & Gafni, A. (2014) · Journal of Comparative Effectiveness Research · doi:10.2217/cer.13.91 · Cited by 38
Decision coaching using the Ottawa family decision guide with parents and their children: a field testing study
Feenstra, B., Lawson, M. L., Harrison, D., Boland, L., & Stacey, D. (2015) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-014-0126-2 · Cited by 35
“that lack concordance with the values and preferences of the child [4,6,7].”
Background
Interventions for promoting participation in shared decision-making for children with cancer
Coyne, I., O'Mathúna, D. P., Gibson, F., Shields, L., & Sheaf, G. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008970.pub2 · Cited by 120
Advancing the adoption, integration and testing of technological advancements within existing care systems
Druss, B. G., & Dimitropoulos, L. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.03.012 · Cited by 32
Who decides? Shared decision-making among colorectal cancer surgery patients in China
Zhai, H., Lavender, C., Li, C., Wu, H., Gong, N., & Cheng, Y. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05391-3 · Cited by 50

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)
DOI: 10.1016/s0277-9536(96)00221-3
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)

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