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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Goel, V., Sawka, C., Thiel, E., Gort, E. H., & O'Connor, A. (2001) · Medical decision making · doi:10.1177/0272989x0102100101 · Cited by 193
“A second criticism has been that anxiety may be increased through the use of shared decision making.(26,28) Anxiety was high at baseline, consistent with previous studies of newly diagnosed cancer and surgical patients.”
Result
Shared decision making and non-directiveness in genetic counselling
Elwyn, G. J., Gray, J., & Clarke, A. (2000) · Journal of Medical Genetics · doi:10.1136/jmg.37.2.135 · Cited by 184
“Shared decision making provides an approach that is complementary to the “non-directive” approach, and it provides a framework that is open to evaluation.”
Background
What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study
Ford, S., Schofield, T., & Hope, T. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(02)00056-4 · Cited by 183
Impact of the Ottawa Decision Support Framework on the Agreement and the Difference between Patients' and Physicians' Decisional Conflict
Légaré, F., O'Connor, A. M. C., Graham, I. D., Wells, G. A., & Tremblay, S. (2006) · Medical Decision Making · doi:10.1177/0272989x06290492 · Cited by 184
Prevalence and associations of limited health literacy in chronic kidney disease: a systematic review
Fraser, S. D., Roderick, P. J., Casey, M., Taal, M. W., Yuen, H. M., & Nutbeam, D. (2012) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfs371 · Cited by 180
“While CKD is more common in lower socio-economic groups and certain ethnic minorities [13], more evidence is needed on socioeconomic disparities in CKD process and outcome (particularly in pre-ESKD stages of CKD) and consideration of the role of limited HL in adversely influencing selfmanagement and shared decision-ma…”
Background
Shared Treatment Decision Making: What Does It Mean to Physicians?
Charles, C. A., Whelan, T. J., Gafni, A., Willan, A., & Farrell, S. (2003) · Journal of Clinical Oncology · doi:10.1200/jco.2003.05.057 · Cited by 179
Patient-based outcome results from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice
Edwards, A. (2004) · Family Practice · doi:10.1093/fampra/cmh402 · Cited by 179
The development of COMRADE—a patient-based outcome measure to evaluate the effectiveness of risk communication and treatment decision making in consultations
Edwards, A., Elwyn, G. J., Hood, K., Robling, M. R., Atwell, C., Holmes-Rovner, M. M., Kinnersley, P., Houston, H., & Russell, I. T. (2003) · Patient Education and Counseling · doi:10.1016/s0738-3991(03)00055-7 · Cited by 177
“The former is a situation in which the informed choice model [2] of decision making is prevalent.”
BackgroundInfluential
What Is Shared in Shared Decision Making? Complex Decisions When the Evidence Is Unclear
Epstein, R. M., & Gramling, R. E. (2012) · Medical Care Research and Review · doi:10.1177/1077558712459216 · Cited by 188
“They also are concerned that their values and preferences be taken into account but may not want to make the actual decision (Charles et al., 1997; Charles, Whelan, Gafni, Willan, & Farrell, 2003; Strull, Lo, & Charles, 1984).”
Background
Shared decision making in 2017: International accomplishments in policy, research and implementation
Härter, M. C., Moumjid, N., Cornuz, J., Elwyn, G. J., & van der Weijden, T. (2017) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2017.05.024 · Cited by 178
Development and first validation of the shared decision-making questionnaire (SDM-Q)
Simón, D., Schorr, G., Wirtz, M. A., Vodermaier, A., Caspari, C., Neuner, B., Spies, C., Krones, T., Keller, H., Edwards, A., et al. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.04.012 · Cited by 179
Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group
The Panther Symposium ACL Treatment Consensus Group, Diermeier, T., Rothrauff, B. B., Engebretsen, L., Lynch, A. D., Ayeni, O. R., Paterno, M. V., Xerogeanes, J. W., Fu, F. H., Karlsson, J., et al. (2020) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-020-06012-6 · Cited by 177
An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making
McGirt, M. J., Bydon, M., Archer, K. R., Devin, C. J., Chotai, S., Parker, S. L., Nian, H., Harrell, F. E., Speroff, T., Dittus, R. S., et al. (2017) · Journal of Neurosurgery: Spine · doi:10.3171/2016.11.spine16526 · Cited by 176
Interpretive Review : Feasibility and Effects of Decision Aids
Molenaar, S., Sprangers, M. A. G., Postma-Schuit, F. C. E., Rutgers, E. J. T., Noorlander, J., Hendriks, J., & de Haes, J. C. J. M. (2000) · Medical Decision Making · doi:10.1177/0272989x0002000114 · Cited by 176
Designing AI for Trust and Collaboration in Time-Constrained Medical Decisions: A Sociotechnical Lens
Jacobs, M., He, J., F. Pradier, M., Lam, B., Ahn, A. C., McCoy, T. H., Perlis, R. H., Doshi-Velez, F., & Gajos, K. Z. (2021) · Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems · doi:10.1145/3411764.3445385 · Cited by 177
“While AI research continues to focus on improving information accuracy for clinicians, modern clinical care aspires toward shared decisionmaking with patients and clinicians working together to make decisions [12, 39].”
Background
Shared decision making models to inform an interprofessional perspective on decision making: A theory analysis
Stacey, D., Légaré, F., Pouliot, S., Kryworuchko, J., & Dunn, S. (2009) · Patient Education and Counseling · doi:10.1016/j.pec.2009.10.015 · Cited by 169
“Sources that informed the models included research studies [3,25,27,28,30–33], other conceptual models [23,27,29,30,32,34], systematic reviews [3,13,15], clinical practice [24], and personal experiences [27].”
BackgroundMethodInfluential
Shared decision making in mental health: prospects for personalized medicine
Drake, R. E., Cimpean, D., & Torrey, W. C. (2009) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2009.11.4/redrake · Cited by 173
“Because of personal values and subjective responses, patients themselves can best evaluate tradeoffs in efficacy and side effects.(13,14) In mental health, shared decision making enhances the working relationship needed to optimize long-term outcomes.”
Background
Shared Decision-Making and Children With Disabilities: Pathways to Consensus
Adams, R. C., & Levy, S. E. (2017) · PEDIATRICS · doi:10.1542/peds.2017-0956 · Cited by 177
“This clinical report provides the following: (1) a basis for a systematic approach to implementation of SDM; (2) a narrative overview of the literature for application of SDM techniques; (3) exemplars and guidance for use of SDM for children with intellectual, physical, and/or neurodevelopmental disabilities and their…”
BackgroundMethod
Patient–doctor decision-making about treatment within the consultation—A critical analysis of models
Wirtz, V. J., Cribb, A., & Barber, N. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.05.017 · Cited by 168
Patient centered decision making in palliative cancer treatment: a world of paradoxes
de Haes, J. C. J. M., & Koedoot, N. (2003) · Patient Education and Counseling · doi:10.1016/s0738-3991(03)00079-x · Cited by 167
A Typology of Advance Statements in Mental Health Care
Henderson, C., Swanson, J. W., SZMUKLER, G. I., Thornicroft, G., & Zinkler, M. (2008) · Psychiatric Services · doi:10.1176/ps.2008.59.1.63 · Cited by 166
Use of the 9-item Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) in intervention studies—A systematic review
Doherr, H., Christalle, E., Kriston, L., Härter, M. C., & Scholl, I. (2017) · PLoS ONE · doi:10.1371/journal.pone.0173904 · Cited by 165
Cultural influences on the physician–patient encounter: The case of shared treatment decision-making
Charles, C. A., Gafni, A., Whelan, T. J., & O’Brien, M. A. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.06.018 · Cited by 165
How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting
Breckenridge, K., Bekker, H. L., Gibbons, E., van der Veer, S. N., Abbott, D., Briançon, S., Cullen, R., Garneata, L., Jager, K., Lønning, K., et al. (2015) · Nephrology, Dialysis and Transplantation · doi:10.1093/ndt/gfv209 · Cited by 150
Informing And Involving Patients To Improve The Quality Of Medical Decisions
Fowler, F. J., Levin, C. A., & Sepucha, K. (2011) · Health Affairs · doi:10.1377/hlthaff.2011.0003 · Cited by 164
Shared decision making: Physicians’ preferred role, usual role and their perception of its key components
Driever, E. M., Stiggelbout, A. M., & Brand, P. L. P. (2019) · Patient Education and Counseling · doi:10.1016/j.pec.2019.08.004 · Cited by 176
Shared decision making: What is the work?
Elwyn, G. J. (2020) · Patient Education and Counseling · doi:10.1016/j.pec.2020.11.032 · Cited by 181
Perceived Ambiguity About Cancer Prevention Recommendations: Relationship to Perceptions of Cancer Preventability, Risk, and Worry
Han, P. K. J., Moser, R. P., & Klein, W. M. P. (2006) · Journal of Health Communication · doi:10.1080/10810730600637541 · Cited by 168

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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