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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Gaissmaier, W., & Gigerenzer, G. (2008) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2008.08.013 · Cited by 71
“Shared decision making relies on the exchange of information between the physician and the patient and the involvement of both patient and physician in making the decision [9].”
Background
Shared Decision Making Among Individuals With Cancer in Non-Western Cultures: A Literature Review
Obeidat, R., Homish, G. G., & Lally, R. M. (2013) · Oncology nursing forum · doi:10.1188/13.onf.454-463 · Cited by 71
Instruments to assess the perception of physicians in the decision-making process of specific clinical encounters: a systematic review
Légaré, F., Moher, D., Elwyn, G. J., LeBlanc, A., & Gravel, K. (2007) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-7-30 · Cited by 71
Older People's Experiences of Patient-Centered Treatment for Chronic Pain: A Qualitative Study
Teh, C. F., Karp, J. F., Kleinman, A., Reynolds, C. F., Weiner, D. K., & Cleary, P. D. (2009) · Pain Medicine · doi:10.1111/j.1526-4637.2008.00556.x · Cited by 71
Evaluating the quality of shared decision making during the patient-carer encounter: a systematic review of tools
Bouniols, N., Leclère, B., & Moret, L. (2016) · BMC Research Notes · doi:10.1186/s13104-016-2164-6 · Cited by 70
“The healthcare professional and patient share medical information, in particular scientific evidence, and the patient receives the support required to express his/ her preferences and to consider the various healthcarerelated options, in order to reach an informed joint decision [3, 4].”
Background
Patient Involvement in Shared Decision-Making: Do Patients Rate Physicians and Nurses Differently?
Galletta, M., Piazza, M. F., Meloni, S. L., Chessa, E., Piras, I., Arnetz, J. E., & d’Aloja, E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192114229 · Cited by 88
“The additional value of this interactive approach between patient and care provider is increased patient autonomy and empowerment, involving the sharing of ideas, perspectives, and intentions in the caring process [13,14].”
Background
Antipsychotic medication, sedation and mental clouding: An observational study of psychiatric consultations
Seale, C. F., Chaplin, R., Lelliott, P. T., & Quirk, A. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.03.047 · Cited by 70
The decisional conflict scale: moving from the individual to the dyad level
Légaré, F., LeBlanc, A., Robitaille, H., & Turcotte, S. (2012) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2012.02.021 · Cited by 71
Should I stay or should I go?’ Deciding whether to go to hospital after a 999 call
Porter, A. M., Snooks, H. A., Youren, A., Gaze, S., Whitfield, R., Rapport, F., & Woollard, M. (2007) · Journal of Health Services Research & Policy · doi:10.1258/135581907780318392 · Cited by 70
Decisional needs assessment regarding Down syndrome prenatal testing: a systematic review of the perceptions of women, their partners and health professionals
St‐Jacques, S., Grenier, S., Charland, M., Forest, J., Rousseau, F., & Légaré, F. (2008) · Prenatal Diagnosis · doi:10.1002/pd.2059 · Cited by 70
Clinical decision-making and therapeutic approaches in osteopathy – A qualitative grounded theory study
Thomson, O. P., Petty, N. J., & Moore, A. P. (2013) · Manual Therapy · doi:10.1016/j.math.2013.07.008 · Cited by 70
“Active patient involvement in decision-making is now widely considered fundamental (Charles et al., 1997; Entwistle and Watt, 2006; DoH, 2012) and is harmonious with conceptions of patient-centred care (Mead and Bower, 2000; Stewart, 2001).”
Background
Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare
Chong, W. W., Aslani, P., & Chen, T. F. (2013) · Journal of Interprofessional Care · doi:10.3109/13561820.2013.767225 · Cited by 70
Training physicians in shared decision-making—Who can be reached and what is achieved?
Bieber, C. S., Nicolai, J., Hartmann, M., Blumenstiel, K., Ringel, N., Schneider, A., Härter, M. C., Eich, W., & Loh, A. (2009) · Patient Education and Counseling · doi:10.1016/j.pec.2009.03.019 · Cited by 69
“Shared decision-making (SDM) is increasingly advocated as the ideal model of physician–patient interaction when it comes to making healthcare decisions [1–5].”
Background
Shared Decision-Making: Benefits, Barriers and Current Opportunities for Application
Simmons, M. B., Hetrick, S. E., & Jorm, A. F. (2010) · Australasian Psychiatry · doi:10.3109/10398562.2010.499944 · Cited by 68
Patients’ and Psychiatrists’ Perceptions of Clinical Decisions During Schizophrenia Treatment
Hamann, J., Mendel, R. T., Fink, B., Pfeiffer, H., Cohen, R., & Kissling, W. (2008) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e31816a62a0 · Cited by 69
“SDM aims at engaging patients to a greater extent in medical decisions by decreasing the information and power asymmetry between doctors and patients (Charles et al., 1997).”
BackgroundInfluential
The Place of Social Recovery in Mental Health and Related Services
Ramon, S. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15061052 · Cited by 78
What are the Unmet Needs and Most Relevant Treatment Outcomes According to Patients with Inflammatory Bowel Disease? A Qualitative Patient Preference Study
Schoefs, E., Vermeire, S., Ferrante, M., Sabino, J., Lambrechts, T., Avedano, L., Haaf, I., Rocchis, M. S. D., Broggi, A., Sajak-Szczerba, M., et al. (2022) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjac145 · Cited by 69
Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)
Puschner, B., Becker, T. M., Mayer, B., Jordan, H., Maj, M., Fiorillo, A., Égerházi, A., Ivánka, T., Munk‐Jørgensen, P., Bording, M. K., et al. (2015) · Epidemiology and Psychiatric Sciences · doi:10.1017/s204579601400078x · Cited by 69
“Three of decision making styles have been proposed to characterise the degree of patient involvement in decision making: passive or paternalistic (decision is made by the staff, patient consents), shared (information is shared and decision jointly made) and active (staff informs, patient decides) (Charles et al. 1997;…”
Background
Experiences of treatment decision making for young people diagnosed with depressive disorders: a qualitative study in primary care and specialist mental health settings
Simmons, M. B., Hetrick, S. E., & Jorm, A. F. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-194 · Cited by 69
“The most common model of SDM is that described by Charles and colleagues [24], which involves three major steps: 1) two parties (e.”
Background
Improving understanding and rigour through triangulation: an exemplar based on patient participation in interaction
Jones, A., & Bugge, C. (2006) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2006.03953.x · Cited by 69
Recognizing diversity in public preferences: The use of preference sub‐groups in cost‐effectiveness analysis
Sculpher, M. J., & Gafni, A. (2001) · Health Economics · doi:10.1002/hec.592 · Cited by 69
Development of an Instrument to Measure Parents’ Preferences and Goals for the Treatment of Attention Deficit–Hyperactivity Disorder
Fiks, A. G., Mayne, S. L., Hughes, C. C., DeBartolo, E., Behrens, C., Guevara, J. P., & Power, T. J. (2012) · Academic Pediatrics · doi:10.1016/j.acap.2012.04.009 · Cited by 68
“INTRODUCTION SHARED DECISION MAKING (SDM) involves the active participation of both clinicians and families in treatment decisions, the exchangeof information, discussion of preferences, and a joint determination of the treatment plan.(1) This process helps families and clinicians balance the risks and benefits of dif…”
Background
Negotiation in Type 2 Diabetes Counseling: From Problem Recognition to Mutual Acceptance During Lifestyle Counseling
Karhila, P., Kettunen, T., Poskiparta, M., & Liimatainen, L. (2003) · Qualitative Health Research · doi:10.1177/1049732303257153 · Cited by 68
“This tradition is maintained not only by health professionals but also by patients, who, because of their prior experiences, might assume the role of receivers of counseling instead of equal partners (Charles et al., 1997; Trnobranski, 1994; Walker, Arnold, Miller-Day, & Webb, 2001).”
Background
Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views
Bomhof‐Roordink, H., Fischer, M. J., van Duijn‐Bakker, N., Baas-Thijssen, M. C. M., van der Weijden, T., Stiggelbout, A. M., & Pieterse, A. H. (2018) · Psycho-Oncology · doi:10.1002/pon.4923 · Cited by 68
“Moreover, oncologists and cancer patients often meet for the first time when a treatment decision is required and then need to choose between options that often have irreversible and enduring side effects,(13) often within a limited time.(14) All this may result in significant feelings of vulnerability and fear in pat…”
Background
The Role of Shared Decision Making in Pediatric Food Allergy Management
Anagnostou, A., Hourihane, J. O., & Greenhawt, M. (2019) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2019.09.004 · Cited by 68
The use of artificial intelligence and virtual reality in doctor-patient risk communication: A scoping review
Antel, R., Rahimi, S. A., Guadagno, E., Harley, J. M., & Poenaru, D. (2022) · Patient Education and Counseling · doi:10.1016/j.pec.2022.06.006 · Cited by 73
The patient perspective on diversity-sensitive care: a systematic review
Lauwers, E. D. L., Vandecasteele, R., McMahon, M., Maesschalck, S. D., & Willems, S. J. T. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02189-1 · Cited by 79
“Charles and colleagues [45] define shared decision-making as a collaborative process in which both physician and patient being share information and strive to reach consensus on the preferred treatment.”
Background
‘What is this active surveillance thing?’ Men's and partners' reactions to treatment decision making for prostate cancer when active surveillance is the recommended treatment option
O'Callaghan, C., Dryden, T., Hyatt, A., Brooker, J., Burney, S., Wootten, A., White, A. T., Frydenberg, M., Murphy, D., Williams, S., et al. (2014) · Psycho-Oncology · doi:10.1002/pon.3576 · Cited by 71
“Although doctors should offer men unbiased opportunities for shared decision making [37], which may include partners, men’s self-determined choice to not make health care decisions [38] should also be respected.”
Background
In Absentia: An Exploratory Study of How Patients Are Considered in Multidisciplinary Cancer Team Meetings
Hahlweg, P., Hoffmann, J., Härter, M. C., Frosch, D. L., Elwyn, G. J., & Scholl, I. (2015) · PLoS ONE · doi:10.1371/journal.pone.0139921 · Cited by 68
“, the physician medical knowledge and the patient his or her values, preferences and goals for care) and they subsequently come to a decision that both parties can agree on [16, 17].”
Background
Modeling patient-centered communication: Oncologist relational communication and patient communication involvement in breast cancer adjuvant therapy decision-making
Step, M. M., Rose, J. H., Albert, J. M., Cheruvu, V. K., & Siminoff, L. A. (2009) · Patient Education and Counseling · doi:10.1016/j.pec.2009.09.010 · Cited by 68
Shared Decision-Making and Health Care Expenditures Among Children With Special Health Care Needs
Fiks, A. G., Mayne, S. L., Localio, A. R., Alessandrini, E. A., & Guevara, J. P. (2011) · PEDIATRICS · doi:10.1542/peds.2011-1352 · Cited by 68
“2% Mean total health expendituresa: in year 1b 2131 2050 2111 2222 2178 in year 2 2071 1711 2033 2204 2423 change (95% CI)c 260 (2202, 82) 2339 (2660, 221) 278 (2260, 104) 218 (2459, 422) 245 (2181, 672) Mean out-of-pocket expendituresa: in year 1b 389 398 396 392 351 in year 2 374 333 384 334 428 change (95% CI)c 215…”
BackgroundInfluential
Models of the medical consultation: opportunities and limitations of a game theory perspective
Tarrant, C. (2004) · BMJ Quality & Safety · doi:10.1136/qhc.13.6.461 · Cited by 68
Shared decision making coding systems: how do they compare in the oncology context?
Butow, P., Juraskova, I., Chang, S., Lopez, A.-L., Brown, R. P., & Bernhard, J. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2009.06.009 · Cited by 60
Patients’ Understanding of Shared Decision Making in a Mental Health Setting
Eliacin, J., Salyers, M. P., Kukla, M., & Matthias, M. S. (2014) · Qualitative Health Research · doi:10.1177/1049732314551060 · Cited by 71
“However, participants also saw dimensions to shared decision making that Charles et al. (1997) did not discuss.”
Background
Views of treatment decision making from adolescents with chronic illnesses and their parents: a pilot study
Knopf, J., Hornung, R., Slap, G. B., DeVellis, R. F., & Britto, M. T. (2008) · Health Expectations · doi:10.1111/j.1369-7625.2008.00508.x · Cited by 73
What Is a “Good” Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer
Orom, H., Biddle, C., Underwood, W., Nelson, C. J., & Homish, D. L. (2016) · Medical Decision Making · doi:10.1177/0272989x16635633 · Cited by 72
Physicians' Communicative Strategies in Interacting With Internet-Informed Patients: Results From a Qualitative Study
Caiata-Zufferey, M., & Schulz, P. J. (2012) · Health Communication · doi:10.1080/10410236.2011.636478 · Cited by 67

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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