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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Veterinarians’ role in clients’ decision-making regarding seriously ill companion animal patients
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“In human medicine, it has been shown that patients may have different preferences regarding the involvement of doctors in decision-making—that some want to make their own decisions, some want to share the decision-making, and some prefer to delegate responsibility to the doctor [11].”
Background
Enabling Precision Cardiology Through Multiscale Biology and Systems Medicine
Johnson, K. W., Shameer, K., Glicksberg, B. S., Readhead, B., Sengupta, P. P., Björkegren, J. L. M., Kovacic, J. C., & Dudley, J. T. (2017) · JACC: Basic to Translational Science · doi:10.1016/j.jacbts.2016.11.010 · Cited by 83
The science-to-service gap in real-world schizophrenia treatment: the 95% problem.
Drake, R., & Essock, S. (2009) · Schizophrenia bulletin · doi:10.1093/schbul/sbp047 · Cited by 58
Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study
Hisham, R., Ng, C. J., Liew, S. M., Hamzah, N., & Ho, G. J. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010565 · Cited by 83
“This may be overcome by using the shared decision-making model where both parties discuss, negotiate and agree on the decision.(26) Private healthcare settings have been struggling to fulfil the need to practise EBM due to financial constraints; problems remain with lack of drug resources.”
Background
Impact of Shared Decision Making on Disease-Modifying Drug Adherence in Multiple Sclerosis
Ben‐Zacharia, A. B., Adamson, M., Boyd, A., Hardeman, P., Smrtka, J., Walker, B. D., & Walker, T. (2018) · International Journal of MS Care · doi:10.7224/1537-2073.2017-070 · Cited by 83
Beyond patient-centred care: a conceptual framework of co-production mechanisms with vulnerable groups in health and social service settings
Park, S. (2019) · Public Management Review · doi:10.1080/14719037.2019.1601241 · Cited by 87
“The professional clinician possesses technical expertise and authority, while the patient has private knowledge of and authority over their own body (Charles, Gafni, and Whelan 1997; Gerteis et al. 1993).”
Background
Factors influencing patients’ preferences and perceived involvement in shared decision-making in mental health care
Eliacin, J., Salyers, M. P., Kukla, M., & Matthias, M. S. (2014) · Journal of Mental Health · doi:10.3109/09638237.2014.954695 · Cited by 83
“SDM involves collaborative partnership between patients and providers who are both considered experts and are expected to participate in deliberation about treatment decisions (Charles et al., 1997).”
Measuring (shared) decision-making – a review of psychometric instruments
Simón, D., Loh, A., & Härter, M. C. (2007) · Zeitschrift für ärztliche Fortbildung und Qualität im Gesundheitswesen - German Journal for Quality in Health Care · doi:10.1016/j.zgesun.2007.02.029 · Cited by 80
A matter of trust: patient barriers to primary medication adherence
Polinski, J. M., Kesselheim, A. S., Frolkis, J. P., Wescott, P. H., Allen-Coleman, C., & Fischer, M. A. (2014) · Health Education Research · doi:10.1093/her/cyu023 · Cited by 90
“How else can a collaborative relationship be introduced and strengthened, even as most providers (and patients) do not receive communication skills training? A promising approach is the use of decision support tools, which provide structure to the decisionmaking process, breaking it down into smaller, manageable steps…”
Background
Wake up, wake up! It’s me! It’s my life!patient narratives on person-centeredness in the integrated care context: a qualitative study
Greenfield, G., Ignatowicz, A., Belsi, A., Pappas, Y., Car, J., Majeed, A., & Harris, M. J. (2014) · BMC Health Services Research · doi:10.1186/s12913-014-0619-9 · Cited by 84
“Shifts from the traditional biomedical, paternalistic model to more symmetrical models emphasize the joint negotiation and partnership between physicians and patients, empowering patients to take a proactive role in their care [18,19].”
Background
Current concepts of shared decision making in orthopedic surgery
Klifto, K. M., Klifto, C. S., & Slover, J. D. (2017) · Current Reviews in Musculoskeletal Medicine · doi:10.1007/s12178-017-9409-4 · Cited by 83
A qualitative systematic review of internal and external influences on shared decision-making in all health care settings
Truglio‐Londrigan, M., Slyer, J. T., Singleton, J. K., & Worral, P. (2012) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2012-432 · Cited by 84
“JBI Database of Systematic Reviews & Implementation Reports 2014;12(5) 121 - 194”
Background
Strategies to evaluate healthcare provider trainings in shared decision-making (SDM): a systematic review of evaluation studies
Müller, E., Strukava, A., Scholl, I., Härter, M. C., Diouf, N. T., Légaré, F., & Buchholz, A. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026488 · Cited by 84
“In SDM, the patient and at least one clinician share information and values, deliberate the next step and arrive at a jointly made decision.(3) Patients who experienced SDM reported less decisional conflict and improved satisfaction,(4) but evidence regarding health-related outcomes is limited.”
Background
Informed Decision Making in Maternity Care
Goldberg, H. B. (2009) · The Journal of Perinatal Education · doi:10.1624/105812409x396219 · Cited by 82
Making Sense of “Consumer Engagement” Initiatives to Improve Health and Health Care: A Conceptual Framework to Guide Policy and Practice
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“This contrasts with the historical interpretation of “patient” as one who relies on his or her providers to make health-related decisions on his or her behalf (Brody 1980; Charles, Gafni, and Whelan 1997; Parsons 1951).”
Result
Exploring the decision‐making preferences of people with colorectal cancer
Beaver, K., Jones, D. J., Susnerwala, S. S., Craven, O., Tomlinson, M., Witham, G., & Luker, K. A. (2005) · Health Expectations · doi:10.1111/j.1369-7625.2005.00320.x · Cited by 81
Involving patients in primary care consultations: assessing preferences using discrete choice experiments.
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Integrating Decision Making and Mental Health Interventions Research: Research Directions.
Wills, C. E., & Holmes-Rovner, M. M. (2006) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2006.00002.x · Cited by 80
Racial and Ethnic Disparities in Neuraxial Labor Analgesia
Toledo, P., Sun, J., Grobman, W. A., Wong, C. A., Feinglass, J. M., & Hasnain‐Wynia, R. (2011) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e318239dc7c · Cited by 81
Information needs and preferences of low and high literacy consumers for decisions about colorectal cancer screening: utilizing a linguistic model
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Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment and mental health care planning
Coffey, M., Cohen, R., Faulkner, A., Hannigan, B., Simpson, A., & Barlow, S. H. (2016) · Health Expectations · doi:10.1111/hex.12474 · Cited by 83
Development of a patient decision aid for choice of surgical treatment for breast cancer
Sawka, C. A., Goel, V., Mahut, C., Taylor, G. A., Thiel, E. C., O'Connor, A. M. C., Ackerman, I., Burt, J. H., & Gort, E. H. (1998) · Health Expectations · doi:10.1046/j.1369-6513.1998.00003.x · Cited by 80
Shared Decision Making and Treatment Decisions for Young Children With Autism Spectrum Disorder
Levy, S. E., Frasso, R., Colantonio, S., Reed, H., Stein, G., Barg, F. K., Mandell, D. S., & Fiks, A. G. (2016) · Academic Pediatrics · doi:10.1016/j.acap.2016.04.007 · Cited by 80
Shared decision making in school age children with asthma.
Butz, A. M., Walker, J. M., Pulsifer, M., & Winkelstein, M. L. (2007) · PubMed · Cited by 80
Brief report: Training internists in shared decision making about chronic opioid
Sullivan, M. D., Leigh, J., & Gaster, B. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00352.x · Cited by 80
Numbers Matter to Informed Patient Choices
Peters, E. M., Hart, P. S., Tusler, M., & Fraenkel, L. (2013) · Medical Decision Making · doi:10.1177/0272989x13511705 · Cited by 80
Patient Participation in Decision Making About Care
Sainio, C., Eriksson, E., & Lauri, S. H. (2001) · Cancer Nursing · doi:10.1097/00002820-200106000-00002 · Cited by 80
Lack of Shared Decision Making in Cancer Screening Discussions
Hoffman, R. M., Elmore, J. G., Fairfield, K. M., Gerstein, B. S., Levin, C. A., & Pignone, M. P. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.04.011 · Cited by 79
Toward an Understanding of Advance Care Planning in Children With Medical Complexity
Orkin, J., Beaune, L., Moore, C., Weiser, N., Arje, D., Rapoport, A., Netten, K., Adams, S. L., Cohen, E., & Amin, R. (2020) · PEDIATRICS · doi:10.1542/peds.2019-2241 · Cited by 79
When western concept meets eastern culture: Exploring the impact of Confucianism on shared decision-making in China
Meng, M., Li, X., Zhao, J., & Hao, Y. (2024) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2024.100586 · Cited by 79
Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey
Ekdahl, A., Andersson, L. F., Wiréhn, A.-B., & Friedrichsen, M. (2011) · BMC Geriatrics · doi:10.1186/1471-2318-11-46 · Cited by 80
“Information and communication are basic requirements for participation [30].”
Background
Perceived Ambiguity about Screening Mammography Recommendations: Association with Future Mammography Uptake and Perceptions
Han, P. K. J., Kobrin, S. C., Klein, W. M. P., Davis, W. W., Stefanek, M. E., & Taplin, S. H. (2007) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-06-0533 · Cited by 82
“The rise of the evidence-based medicine movement has stimulated critical examination of both novel and well-established interventions, whereas a growing emphasis upon informed decision making (1-8) has engendered a renewed focus on increasing patients’ awareness of scientific uncertainty and conflicts in expert opinio…”
Background
Towards a relational model of decision-making in midwifery care
Noseworthy, D. A., Phibbs, S., & Benn, C. (2012) · Midwifery · doi:10.1016/j.midw.2012.06.022 · Cited by 79
“…treatments (Green et al., 1998) in some situations the client may be stressed or frightened which will interfere with their ability to assimilate and/or process the information (Douché, 2007) and lessen their desire to participate in decision-making (Charles et al., 1997; Harrison et al., 2003).”
BackgroundMethodInfluential
Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations
van Boven, J. F. M., Ryan, D. P., Eakin, M. N., Canonica, G. W., Barot, A., & Foster, J. M. (2016) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2016.03.007 · Cited by 81
“Shared decision making can be defined as an active mutual partnership between the health care provider and the patient in which both parties share information, values, preferences, and decisions about treatment.(43,44) Shared decision making has been effective and cost-effective in patients with asthma,(45) but the ap…”
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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