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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“, one’s social situation, attitudes to risk, values, and preferences) [17,21,22].”
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“12 For example, women with early-stage breast cancer are often faced with the decisions of breast-conserving surgery versus mastectomy and, after surgery, whether to undergo adjuvant chemotherapy or radiation.”
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“[13], SDM is especially important in cancer care.”
Background
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Background
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“Studies generally find that patients who actively seek health information, openly communicate with health care providers, and express treatment preferences have better information to inform their decision-making, greater desire to engage in services/treatment, and fewer symptoms (Adams and Drake 2006; Charles et al. 1…”
Background
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“a Components of SDM: (1) both the doctor and the patient are involved in the treatment decision-making process; (2) both”
Background
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“From an autonomy perspective, the former conception seems easy to reconcile with the apparent fact that not all patients want to talk much about themselves, engage much in dialogues, collaborate much in decision making, and so on [8, 9 , 11, 21, 38, 55].”
Background
Decision making in recovery-oriented mental health care.
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“In spite of this, most of the observed decisions fell short of what constitutes SDM as defined by Charles et al. (1997, 1999) and Montori et al. (2006).”
Result
Supporting Shared Decisions When Clinical Evidence Is Low
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“In other words, they wanted some form of shared decision-making between themselves and the doctor (Charles et al., 1997).”
Background
Perceived ambiguity about cancer prevention recommendations: associations with cancer‐related perceptions and behaviours in a US population survey
Han, P. K. J., Moser, R. P., & Klein, W. M. P. (2007) · Health Expectations · doi:10.1111/j.1369-7625.2007.00456.x · Cited by 124
Anticipate and Communicate Ethical Management of Incidental and Secondary Findings in the Clinical, Research, and Direct-to- Consumer Contexts
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Physician-Identified Factors Affecting Patient Participation in Reaching Treatment Decisions
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Performing deservingness. Humanitarian health care provision for migrants in Germany
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Shared decision-making for people with asthma
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Marriage and ethnicity predict treatment in localized prostate carcinoma
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“Wives may enhance the quality of decision-making by gathering information, coaching the patient to ask questions, or advising about treatment.(16) 1824 CANCER May 1, 2005 / Volume 103 / Number 9”
Background
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Charles, C. A., Gafni, A., Whelan, T. J., & O’Brien, M. A. (2005) · Health Expectations · doi:10.1111/j.1369-7625.2005.00325.x · Cited by 102
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“Shared Decision Making Shared decisionmaking is seen as useful in enabling practitioners to be culturally competent communicators (28) by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient’s specific health characteristics and values when choosing health care…”
Background
Shared decision-making interventions for people with mental health conditions
Aoki, Y., Yaju, Y., Utsumi, T., Sanyaolu, L. N., Storm, M., Takaesu, Y., Watanabe, K., Watanabe, N., Duncan, E., & Edwards, A. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007297.pub3 · Cited by 114
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“Finally, because shared decision-making requires time for discussion and deliberation (Table 1) [10], we described physicians' views about the availability of time in patient visits (consultations).”
BackgroundMethodInfluential
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Physician–patient discussions of controversial cancer screening tests11The full text of this article is available via AJPM Online at www.elsevier.com/locate/ajpmonline.
Dunn, A. S., Shridharani, K., Lou, W. W.-Y., Bernstein, J., & Horowitz, C. R. (2001) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(00)00288-9 · Cited by 100
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Shared decision making in medicine: The influence of situational treatment factors
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“In the last decade shared decision making (SDM) has become increasingly important from an ethical and clinical point of view to ensure that a patient’s voice is heard in medical decision making [1–3].”
BackgroundInfluential
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“It involves not only collaborating in making decisions about treatment, but also sharing information, building consensus about the preferred treatment, and reach of agreement on appropriate treatment (Charles, Gafni, and Whelan, 1997).”
Background
Patient Engagement A Consumer-Centered Model to Innovate Healthcare
Graffigna, G., Barello, S., & Triberti, S. (2015) · doi:10.1515/9783110452440 · Cited by 102
Decision Regret following Breast Reconstruction
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Married couples' perspectives on prostate cancer diagnosis and treatment decision‐making
Boehmer, U., & Clark, J. A. (2001) · Psycho-Oncology · doi:10.1002/pon.504 · Cited by 98
“Caretaker who supports the patient’s treatment decision (Charles et al., 1997).”
Background
Randomized Controlled Trial of a Structured Intervention to Facilitate End-of-Life Decision Making in Patients With Advanced Cancer
Stein, R. A., Sharpe, L., Bell, M. L., Boyle, F. M., Dunn, S. M., & Clarke, S. J. (2013) · Journal of Clinical Oncology · doi:10.1200/jco.2011.40.8872 · Cited by 97
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“Setting an agenda to ensure both parties’ most important concerns are addressed, asking for patient input early in the visit (before discussing treatment decisions), and creating an atmosphere of trust and support using empathy, among other skills specified by the Four Habits, go a long way to invite active patient pa…”
Background
Managing Uncertainty
Gui, X., Kou, Y., Pine, K. H., & Chen, Y. (2017) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3025453.3025891 · Cited by 94
“Shared decisionmaking refers to a collaborative decision-making process in which patients and physicians share information and build a consensus about the preferred treatment to be undertaken [8].”
Background
Expanding the concept of shared decision making for mental health: systematic search and scoping review of interventions
Zisman‐Ilani, Y., Barnett, E. R., Harik, J. M., Pavlo, A. J., & O’Connell, M. J. (2017) · Mental Health Review Journal · doi:10.1108/mhrj-01-2017-0002 · Cited by 96
Determinants of participation in treatment decision-making by older breast cancer patients
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“Although information-giving is an important prerequisite to patient participation in treatment decisionmaking processes [15], the two measures of physician informational support, namely interactive and tangible information-giving, were not important predictors of patient participation, controlling for other factors.”
Background
Physicians' perceptions of shared decision‐making behaviours: a qualitative study demonstrating the continued chasm between aspirations and clinical practice
Zeuner, R., Frosch, D. L., Kuzemchak, M. D., & Politi, M. C. (2014) · Health Expectations · doi:10.1111/hex.12216 · Cited by 98
Patient and general practitioner attitudes to taking medication to prevent cardiovascular disease after receiving detailed information on risks and benefits of treatment: a qualitative study
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“Research from the social sciences has been instrumental in understanding the complexities of shared decision making and the centrality of the effective twoway communication of information [24-29].”
Background
Adapting Shared Decision Making for Individuals With Severe Mental Illness
Hamann, J., & Heres, S. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201400307 · Cited by 95

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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