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
Patients’ Preferences regarding Shared Decision-Making in the Treatment of Inflammatory Bowel Disease: Results from a Patient-Empowerment Study
Baars, J. E., Markus, T., Kuipers, E. J., & van der Woude, C. J. (2010) · Digestion · doi:10.1159/000253862 · Cited by 137
“Shared decision-making is increasingly advocated as an ideal model of treatment decision-making [”
Background
Physician, Patient, and Contextual Factors Affecting Treatment Decisions in Older Adults With Cancer and Models of Decision Making: A Literature Review
Tariman, J. D., Berry, D. L., Cochrane, B. B., Doorenbos, A. Z., & Schepp, K. G. (2011) · Oncology nursing forum · doi:10.1188/12.onf.e70-e83 · Cited by 142
“The doctor-as-agent model describes the physician as an agent helping the patient choose a treatment option that the patient would have chosen if he or she had been as well-informed as the professional (Charles et al., 1997; Charles, Gafni, & Whelan, 1999; McKinstry, 1992).”
Experiences of gestational diabetes and gestational diabetes care: a focus group and interview study
Parsons, J., Sparrow, K., Ismail, K., Hunt, K. F., Rogers, H., & Forbes, A. (2018) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-018-1657-9 · Cited by 141
“This is in contrast to current thinking about models of patient-provider interaction, where the paternalistic model is largely considered to be justified only in emergency situations [39], and principles of shareddecision making [40] and motivational enhancement [41] are generally favoured.”
Result
Shared decision making: trade-offs between narrower and broader conceptions
Cribb, A., & Entwistle, V. A. (2011) · Health Expectations · doi:10.1111/j.1369-7625.2011.00694.x · Cited by 134
Core Competencies for Shared Decision Making Training Programs: Insights From an International, Interdisciplinary Working Group
Légaré, F., Moumjid, N., Drolet, R., Stacey, D., Härter, M. C., Bastian, H., Beaulieu, M., Borduas, F., Charles, C. A., Coulter, A., et al. (2013) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.21197 · Cited by 133
“3,4 Then educators shared information about (1) the rationale for competency-based programs in general, (2) training programs in shared decision making they had designed and implemented (at the local, national, and/or international levels), (3) competencies taught in these programs, (4) findings from evaluations of th…”
BackgroundMethodInfluential
Understanding patient perceptions of shared decision making
Shay, L. A., & Lafata, J. E. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.07.017 · Cited by 137
“This definition includes four key characteristics, all of which must be present to be considered a shared decision: both the patient and clinician are involved in all phases; both parties share information; both parties express treatment preferences; and agreement is reached [7,9].”
Background
Treatment decision-making in chronic diseases: What are the family members’ roles, needs and attitudes? A systematic review
Lamore, K., Montalescot, L., & Untas, A. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.08.003 · Cited by 132
Collaborative Chronic Care Models for Mental Health Conditions
Miller, C. J., Grogan‐Kaylor, A. C., Perron, B. E., Kilbourne, A. M., Woltmann, E. M., & Bauer, M. S. (2013) · Medical Care · doi:10.1097/mlr.0b013e3182a3e4c4 · Cited by 135
Decision analysis in patient care
Elwyn, G. J., Edwards, A., Eccles, M., & Rovner, D. R. (2001) · The Lancet · doi:10.1016/s0140-6736(01)05709-9 · Cited by 129
Mastectomy or Lumpectomy? Helping Women Make Informed Choices
Whelan, T. J., Levine, M. N., Gafni, A., Sanders, K., Willan, A. R., Mirsky, D., Schnider, D., McCready, D. R., Reid, S., Kobylecky, A., et al. (1999) · Journal of Clinical Oncology · doi:10.1200/jco.1999.17.6.1727 · Cited by 129
Assessment of genetic testing and related counseling services: current research and future directions
Wang, C., Gonzalez, R., & Merajver, S. D. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(03)00337-x · Cited by 131
Shared decision making for psychiatric medication management: beyond the micro‐social
Morant, N., Kaminskiy, E., & Ramon, S. (2016) · Health Expectations · doi:10.1111/hex.12392 · Cited by 129
Perceptions of, and willingness to consider, total joint arthroplasty in a population‐based cohort of individuals with disabling hip and knee arthritis
HAWKER, G. A., Wright, J. G., Badley, E. M., & Coyte, P. C. (2004) · Arthritis Care & Research · doi:10.1002/art.20524 · Cited by 131
Cultural basis for differences between US and French clinical recommendations for women at increased risk of breast and ovarian cancer
Eisinger, F., Geller, G., Burke, W., & Holtzman, N. A. (1999) · The Lancet · doi:10.1016/s0140-6736(98)07516-3 · Cited by 128
Patient-centred care in established rheumatoid arthritis
Voshaar, M., Nota, I., van de Laar, M. A. F. J., & van den Bemt, B. J. F. (2015) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2015.09.007 · Cited by 127
Prenatal Consultation Practices at the Border of Viability: A Regional Survey
Bastek, T. K., Richardson, D. K., Zupancic, J. A. F., & Burns, J. P. (2005) · PEDIATRICS · doi:10.1542/peds.2004-1427 · Cited by 127
“Retinopathy of prematurity 148 4 (3) 16 (11) 66 (44) 51 (34) 11 (7) Emotional and financial burdens on family 147 30 (20) 37 (25) 46 (31) 31 (21) 3 (2)”
Goal-Based Shared Decision-Making: Developing an Integrated Model
Elwyn, G., & Vermunt, N. (2019) · Journal of Patient Experience · doi:10.1177/2374373519878604 · Cited by 93
“Expectations, intentions, and goals play a vital part in decision-making, so it seems odd that the early definitions of shared decision-making (SDM) neglected to include these critical aspects of planning future actions (1-6).”
BackgroundMethodInfluential
Racial/ethnic group differences in treatment decision‐making and treatment received among older breast carcinoma patients
Maly, R. C., Umezawa, Y., Ratliff, C. T., & LEAKE, B. D. (2006) · Cancer · doi:10.1002/cncr.21680 · Cited by 127
“However, research regarding treatment decision-making has focused almost exclusively on the dyadic relationship between the patient and the physician, and to our knowledge little is known regarding the role of family in the decision-making process itself and actual treatment decisions made.(30) The involvement of fami…”
Background
Configural algorithms of patient satisfaction, participation in diagnostics, and treatment decisions ' influences on hospital loyalty
Chang, C., Tseng, T., & Woodside, A. G. (2013) · Journal of Services Marketing · doi:10.1108/08876041311309225 · Cited by 130
“A shared decision-making model has been proposed by Charles, Gafni, and Whelan (1997) with the key characteristics: (1) at least two participants (e.g., doctor and patient), (2) both parties share information, (3) they both act to build a consensus about the preferred treatment, and (4) an…”
Background
Recent advances in shared decision making for mental health
Patel, S. R., Henry, S. B., & Ruland, C. M. (2008) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32830eb6b4 · Cited by 126
Variations in reconstruction after radical cystectomy
Gore, J. L., Saigal, C. S., Hanley, J. M., Schonlau, M., Litwin, M. S., & and the Urologic Diseases in America Project (2006) · Cancer · doi:10.1002/cncr.22058 · Cited by 125
Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators
Chong, W. W., Aslani, P., & Chen, T. F. (2013) · Journal of Interprofessional Care · doi:10.3109/13561820.2013.785503 · Cited by 125
Lay constructions of decision‐making in cancer
Henman, M., Butow, P., Brown, R., Boyle, F., & Tattersall, M. (2002) · Psycho-Oncology · doi:10.1002/pon.566 · Cited by 150
“…including multiple participants (family, friends, medical practitioners), multiple decisions over the disease trajectory, and confusion as to what patients actually mean when they declare that they do or do not want to participate in decision-making (Charles et al., 1997; Shidler, 1998).”
Background
Developing ethical strategies to assist oncologists in seeking informed consent to cancer clinical trials
Brown, R., Butow, P. N., Butt, D., Moore, A. R., & Tattersall, M. H. N. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(03)00204-1 · Cited by 128
Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence
Stacey, D., Kryworuchko, J., Belkora, J. K., Davison, B. J., Durand, M., Eden, K., Hoffman, A. S., Körner, M., Légaré, F., Loiselle, M.-C., et al. (2013) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-13-s2-s11 · Cited by 124
“Two-way communication is essential for shared decision making, but does not guarantee that shared decision making has occurred [11,12].”
Background
Perceived role in end-of-life decision making in the NICU affects long-term parental grief response
Caeymaex, L., Jousselme, C., Vasilescu, C., Danan, C., Falissard, B., Bourrat, M.-M., Garel, M., & Speranza, M. (2012) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2011-301548 · Cited by 124
Personalized Decision Making
Haward, M. F., Gaucher, N. O., Payot, A., Robson, K., & Janvier, A. (2017) · Clinics in Perinatology · doi:10.1016/j.clp.2017.01.006 · Cited by 124
The influence of structural and message features on Web site credibility
Hong, T. J. (2005) · Journal of the American Society for Information Science and Technology · doi:10.1002/asi.20258 · Cited by 128
Women’s experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks
Emmett, C. L., Shaw, A., Montgomery, A. A., Murphy, D. J., & DiAMOND study group (2006) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2006.01112.x · Cited by 126
Application of Artificial Intelligence in Shared Decision Making: Scoping Review
Rahimi, S. A., Cwintal, M., Huang, Y., Ghadiri, P., Grad, R. M., Poenaru, D., Gore, G. C., Zomahoun, H. T. V., Légaré, F., & Pluye, P. (2022) · JMIR Medical Informatics · doi:10.2196/36199 · Cited by 136
“The patient is invited and supported in expressing their preferences and values, and eventually, patients and their health care providers collaboratively make a decision that is best aligned with patients’ preferences and values [1].”
Background
"You’re Perfect for the Procedure! Why Don’t You Want It?" Elderly Arthritis Patients’ Unwillingness to Consider Total Joint Arthroplasty Surgery: A Qualitative Study
Hudak, P. L., Clark, J., HAWKER, G. A., Coyte, P. C., Mahomed, N. N., Kreder, H. J., & Wright, J. G. (2002) · Medical Decision Making · doi:10.1177/0272989x0202200315 · Cited by 121
Patients’ perspectives on person-centred participation in healthcare: A framework analysis
Thórarinsdóttir, K., & Kristjánsson, K. (2014) · Nursing Ethics · doi:10.1177/0969733013490593 · Cited by 132
“decision-making in which both parties invest.(22,23) According to the conceptual analyses cited earlier, positive valued communication, relations and sharing of power and information between patients and HCPs are central issues in patient participation.”
BackgroundResult
The Impact of Patient Participation in Health Decisions Within Medical Encounters
Clayman, M. L., Bylund, C. L., Chewning, B. A., & Makoul, G. T. (2015) · Medical Decision Making · doi:10.1177/0272989x15613530 · Cited by 127
Shared Decision-Making for Nursing Practice: An Integrative Review
Truglio‐Londrigan, M., & Slyer, J. T. (2018) · The Open Nursing Journal · doi:10.2174/1874434601812010001 · Cited by 135
“The interpersonal process of communication is bi-directional between the provider and the patient when there is a mutual exchange of information [6, 19, 22, 23, 25, 38, 67, 70, 72].”
Influential
Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study
Wiener, R. S., Koppelman, E. A., Bolton, R. E., Lasser, K. E., Borrelli, B., Au, D. H., Slatore, C. G., Clark, J. A., & Kathuria, H. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4350-9 · Cited by 120
The Impact of a Novel Computer-Based Decision Aid on Shared Decision Making for Colorectal Cancer Screening
Schroy, P. C., Emmons, K. M., Peters, E. M., Glick, J. T., Robinson, P. A., Lydotes, M. A., Mylvanaman, S., Evans, S. R., Chaisson, C. E., Pignone, M. P., et al. (2010) · Medical Decision Making · doi:10.1177/0272989x10369007 · Cited by 120
“19, 20 Unfortunately, SDM has been difficult to implement into routine clinical practice in part due to lack of time, lack of clinician expertise and lack of resources.”
Background
THE MOVING TARGET
Clark, J., Hudak, P. L., HAWKER, G. A., Coyte, P. C., Mahomed, N. N., Kreder, H. J., & Wright, J. G. (2004) · Journal of Bone and Joint Surgery · doi:10.2106/00004623-200407000-00003 · Cited by 120
Experience of rehabilitation following spinal cord injury: a meta-synthesis of qualitative findings
Hammell, K. W. (2007) · Spinal Cord · doi:10.1038/sj.sc.3102034 · Cited by 119
Does Shared Decision Making in Cancer Treatment Improve Quality of Life? A Systematic Literature Review
Kashaf, M., & McGill, E. (2015) · Medical decision making · doi:10.1177/0272989x15598529 · Cited by 116
“This rules out clinical decision making purely on the basis of avowedly objective biomedical knowledge and permits patient preferences to more strongly influence decision making.(9) Finally, even in cases where one treatment option is known to offer better survival outcomes, there may be marked tradeoffs between outco…”
Background

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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