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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Hamann, J., Bühner, M., & Rüsch, N. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201600282 · Cited by 62
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Background
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“ues and preferences—is one key feature of screening (89,90).”
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“Shared decision making (SDM), the fostering of patient involvement in medical decisions, has become an accepted approach [1–3], and momentum around SDM is increasing.”
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Information seeking and avoidance throughout the cancer patient journey: two sides of the same coin? A synthesis of qualitative studies
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“Over the last 30 years, shared decision-making has been increasingly advocated as an ideal model of treatment decision-making in the medical encounter [1,2].”
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Psychoeducation for patients with schizophrenia and their families
Rummel‐Kluge, C., & Kissling, W. (2008) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.8.7.1067 · Cited by 52
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“Following the existing components of the concept [2,3] we analysed the exchange of information and information processing performed by physician and patient using the communication theory of Luhmann [20].”
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Communication and decision-making in mental health: A systematic review focusing on Bipolar disorder
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Involved, inputting or informing: “Shared” decision making in adult mental health care
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Impact of shared decision making on asthma quality of life and asthma control among children
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“treatment plan that considers patient-centered goals and preferences [22,23].”
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Beyond dialysis decisions: a qualitative exploration of decision-making among culturally and linguistically diverse adults with chronic kidney disease on haemodialysis
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Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology
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Learning shared decision-making in clinical practice
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Shared decision‐making in question
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Linking evidence-based medicine therapeutic summary measures to clinical decision analysis.
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“Finally, the parties arrive at a consensus on preferred treatment (11).”
Background
Comparing genetic counseling with non-genetic health care interactions: Two of a kind?
Smets, E. M. A., van Zwieten, M. C. B., & Michie, S. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2007.05.015 · Cited by 51
“Charles et al. [ 66 ] distinguished three models of decision making: in thepaternalistic model the clinician is seen as acting in the patient’s best interest, in the professional as agent model, the clinician also makes the decisions, having solicited the patient’s views, and in the informed model, the clinician incre…”
Background
The Facilitating Role of Chemotherapy in the Palliative Phase of Cancer: Qualitative Interviews with Advanced Cancer Patients
Buiting, H. M., Terpstra, W. E., Dalhuisen, F., Gunnink-Boonstra, N., Sonke, G. S., & den Hartogh, G. A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0077959 · Cited by 51
“Patients’ passive stance in the treatment decision-making is to a certain extent remarkable given the tremendous attention that is paid to implement shared decision-making in the clinical encounter [28–30].”
Background
A Grounded Explanation of Why Women Present with Advanced Breast Cancer
Taib, N. A. M., Yip, C. H., & Low, W. Y. (2013) · World Journal of Surgery · doi:10.1007/s00268-013-2339-4 · Cited by 51
“Shared decision-making occurs when the patient and health care provider discuss and make decisions collectively, with the decision-making responsibility falling on both parties [18].”
Background
Decision-Making Role Preferences Among Patients with HIV: Associations with Patient and Provider Characteristics and Communication Behaviors
Kumar, R., Korthuis, P. T., Saha, S., Chander, G., Sharp, V., Cohn, J., Moore, R. D., & Beach, M. C. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1275-3 · Cited by 51
“Patients answered the question: “What role do you want to play in your medical care?” with one of four responses: ( 1 ) the doctor takes initiative and decides what is best for me, (2) the doctor considers some of my ideas but still makes most, if not all, of the final decisions, (3) the doctor and I make the final de…”
BackgroundInfluential
Predictors of satisfaction with child birth services in public hospitals in Ghana
Avortri, G. S., Beke, A. K., & Abekah‐Nkrumah, G. (2011) · International Journal of Health Care Quality Assurance · doi:10.1108/09526861111116660 · Cited by 50
Decision-Making in Multiple Sclerosis Consultations in Italy: Third Observer and Patient Assessments
Pietrolongo, E., Giordano, A., Kleinefeld, M., Confalonieri, P. A., Lugaresi, A., Tortorella, C., Pugliatti, M., Radice, D., Goss, C., Heesen, C., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0060721 · Cited by 51
“However, despite widespread endorsement of the SDM approach by the medical community, physicians seem to apply it insufficiently during consultations [2,8,18,19,28].”
Arthritis patients’ motives for (not) wanting to be involved in medical decision-making and the factors that hinder or promote patient involvement
Nota, I., Drossaert, C. H. C., Taal, E., & van de Laar, M. A. F. J. (2014) · Clinical Rheumatology · doi:10.1007/s10067-014-2820-y · Cited by 51
Development and pilot of an advance care planning website for women with ovarian cancer: A randomized controlled trial
Vogel, R. I., Petzel, S. V., Cragg, J., McClellan, M. A., Chan, D., Dickson, E. L., Jacko, J. A., Sainfort, F., & Geller, M. A. (2013) · Gynecologic Oncology · doi:10.1016/j.ygyno.2013.08.017 · Cited by 53
“The general approach was based on theories of informed [24,25] and shared decisionmaking [24–26].”
Method
“Well, I Think There Is Great Variation…”: A Qualitative Study of Oncologists' Experiences and Views Regarding Medical Criteria and Other Factors Relevant to Treatment Decisions in Advanced Cancer
Schildmann, J., Tan, J. O. A., Salloch, S., & Vollmann, J. (2013) · The Oncologist · doi:10.1634/theoncologist.2012-0206 · Cited by 51
Shared decision making for infants born at the threshold of viability: a prognosis-based guideline
Lemyre, B., Daboval, T., Dunn, S., Kekewich, M. A., Jones, G., Wang, D., Mason-Ward, M., & Moore, G. P. (2016) · Journal of Perinatology · doi:10.1038/jp.2016.81 · Cited by 51
Prospective parents’ perspectives on antenatal decision making for the anticipated birth of a periviable infant
Edmonds, B. T., Savage, T. A., Kimura, R. E., Kilpatrick, S. J., Kuppermann, M., Grobman, W. A., & Kavanaugh, K. L. (2017) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2017.1393066 · Cited by 51
Trust in dentist‐patient relationships: mapping the relevant concepts
Song, Y., Luzzi, L., & Brennan, D. S. (2020) · European Journal Of Oral Sciences · doi:10.1111/eos.12686 · Cited by 51
How to identify patients with a poor prognosis in daily clinical practice
Cedraschi, C., & Allaz, A. (2005) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2005.03.002 · Cited by 51
The context influences doctors' support of shared decision-making in cancer care
Shepherd, H. L., Tattersall, M. H. N., & Butow, P. N. (2007) · British Journal of Cancer · doi:10.1038/sj.bjc.6603841 · Cited by 51
“The survey presented unlabelled examples constructed from the conceptual framework presented by Charles et al (1997, 1999)in earlier publications to reflect the following decision-making approaches: paternalistic, information-sharing only, informed, and shared (see Figure 1).”
Background
Talking about Spirituality in the Clinical Setting: Can Being Professional Require Being Personal?
Kuczewski, M. G. (2007) · The American Journal of Bioethics · doi:10.1080/15265160701399545 · Cited by 51
“…of the literature on spirituality is concerned with the impact of spirituality on the process of treatment decision-making, a process that has sometimes been idealistically characterized as “shared decision making” between physician and patient (President’s Commission 1982; Charles et al. 1997).”
Background
Impact of an information booklet on satisfaction and decision-making about BRCA genetic testing
Mancini, J., Noguès, C., Adenis, C., Berthet, P., Bonadona, V., Chompret, A., Coupier, I., Eisinger, F., Fricker, J., Gauthier‐Villars, M., et al. (2006) · European Journal of Cancer · doi:10.1016/j.ejca.2005.10.029 · Cited by 51
“informed decision between a woman, her doctor and possibly the patient’s family.(22) Standardizing the delivery of information, designed to complete cancer genetic consultations in the form of a document validated both by doctors and patients, seems to be a promising method of improving patients’ satisfaction and savi…”
Background
Is there a role for decision aids in cancer-related decisions?
Neuman, H. B., Charlson, M. E., & Temple, L. K. F. (2007) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2006.12.006 · Cited by 51
“[92] Video + brochure Breast Knowledge/perceived risk, intended treatment choice, strength of preferences, DCS [1], STAI [3], CES-D [5], IES [6], PSDM [7], satisfaction, optimal timing of DA Improved knowledge, impacted treatment choice, no impact on preferences, no impact on decisional conflict, no impact on anxiety,…”
BackgroundMethodInfluential
Shared Decision Making
Barry, M. J. (2012) · Journal of Ambulatory Care Management · doi:10.1097/jac.0b013e318249482f · Cited by 50
Using freelisting to understand shared decision making in ADHD: Parents’ and pediatricians’ perspectives
Fiks, A. G., Gafen, A., Hughes, C. C., Hunter, K. F., & Barg, F. K. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2010.07.035 · Cited by 50
“035 clinicians and families participate in treatment decisions, exchange information, express preferences, and jointly determine a treatment plan [3].”
Background
Patient autonomy in multiple sclerosis — Possible goals and assessment strategies
Heesen, C., Köpke, S., Solari, A., Geiger, F., & Kasper, J. (2013) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2013.02.018 · Cited by 50
“In medical decisions with a need to involve a health expert PA becomes apparent in the patients' participation in communication as described in the concept of shared decision making [1].”
Background
Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (CEDAR): Study protocol
Puschner, B., Steffen, S., Slade, M., Kaliniecka, H., Maj, M., Fiorillo, A., Munk‐Jørgensen, P., Larsen, J. I., Égerházi, A., Nemes, Z., et al. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-90 · Cited by 51
“[11] proposed three general types of treatment decision making (see Table 1) in which three main activities (information transfer, deliberation, and deciding about implementing treatment) are being considered.”
Background
Chemotherapy near the end of life: a retrospective single-centre analysis of patients’ charts
Adam, H., Hug, S., & Bosshard, G. (2014) · BMC Palliative Care · doi:10.1186/1472-684x-13-26 · Cited by 50
“Both patient and doctor have to participate in this shared decision-making process [13].”
Background
Shared Decision-Making in Cosmetic Medicine and Aesthetic Surgery
Ubbink, D. T., Santema, T. B., & Lapid, O. (2015) · Aesthetic Surgery Journal · doi:10.1093/asj/sjv107 · Cited by 51
The doctor-patient relationship as a toolkit for uncertain clinical decisions
Diamond-Brown, L. (2016) · Social Science & Medicine · doi:10.1016/j.socscimed.2016.05.002 · Cited by 50
“They sometimes also engage patients in shared decision-making, where content and control of decision-making is a shared process (Charles et al., 1997, 1999).”
Factors associated with shared decision making among primary care physicians: Findings from a multicentre cross‐sectional study
Menear, M., Garvelink, M. M., Adekpedjou, R., Pérez, M. M. B., Robitaille, H., Turcotte, S., & Légaré, F. (2017) · Health Expectations · doi:10.1111/hex.12603 · Cited by 52
Keystrokes, Mouse Clicks, and Gazing at the Computer: How Physician Interaction with the EHR Affects Patient Participation
Street, R. L., Liu, L., Farber, N. J., Chen, Y., Calvitti, A., Weibel, N., Gabuzda, M. T., Bell, K., Gray, B., Rick, S., et al. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4228-2 · Cited by 50
Tolerance of Uncertainty and the Practice of Emergency Medicine
Platts‐Mills, T. F., Nagurney, J. M., & Melnick, E. R. (2019) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2019.10.015 · Cited by 50
Head and neck cancer patients’ preferences for individualized prognostic information: a focus group study
Hoesseini, A., Dronkers, E. A. C., Sewnaik, A., Hardillo, J. A., de Jong, R. J. B., & Offerman, M. P. J. (2020) · BMC Cancer · doi:10.1186/s12885-020-6554-8 · Cited by 50
The impact of the perception of treatment choice on satisfaction with treatment, experienced chemotherapy burden and current quality of life
Jansen, S., Otten, W., van de Velde, C. V. D., Nortier, J., & Stiggelbout, A. (2004) · British Journal of Cancer · doi:10.1038/sj.bjc.6601903 · Cited by 56
“Charles et al (1997) stress the importance of shared decision-making in the case of adjuvant chemotherapy, because: (1) several treatment options exist with different possible outcomes and substantial uncertainty, (2) there is often no clear-cut right or wrong answer and (3) the impact of the…”
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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