Shared Decision-Making and Patient Engagement

Shared decision-making is a process in which clinicians and patients work together to choose tests, treatments, or care plans, combining the best clinical evidence with the patient's own values and preferences. Patient engagement is the broader idea of patients taking an active role in their care; together they place the patient at the centre of decisions, especially where reasonable options carry different trade-offs.

Definition

Shared decision-making is a collaborative process in which a clinician and a patient jointly make a health decision, exchanging information so that the patient understands the options and their consequences and the choice reflects the patient's informed preferences; patient engagement is the broader involvement of patients as active participants in their care.

Scope

The entry describes what defines shared decision-making, the conditions that make it especially relevant (preference-sensitive decisions), the tools that support it (patient decision aids), and the related concept of patient activation. It treats these as reference topics in patient-centred care and quality, not as clinical instructions for any particular decision.

Core questions

• What distinguishes shared decision-making from a clinician simply informing or directing a patient?
• Which kinds of decisions most call for sharing the choice with the patient?
• How do tools such as decision aids and concepts such as patient activation support engagement?

Key concepts

• Preference-sensitive decisions
• Patient decision aids
• Choice talk, option talk, decision talk
• Patient activation
• Informed preferences and values clarification
• Patient-centred care

Key theories

The shared decision-making model

Charles and colleagues defined shared decision-making as requiring at least two participants who both take part, share information, and agree on the decision, distinguishing it from paternalistic and purely informed-choice models; Elwyn and colleagues later operationalized it as a sequence of choice talk, option talk, and decision talk.

Mechanisms

Charles and colleagues characterized shared decision-making as needing at least two participants who both engage, exchange information in both directions, and reach agreement on the decision — distinguishing it from a paternalistic model and from one-way informed choice. Elwyn and colleagues translated this into a practical sequence of choice talk (making the patient aware that options exist), option talk (describing the options and their trade-offs), and decision talk (eliciting and integrating the patient's preferences). Patient decision aids — structured tools presenting options and outcomes — support this process, and patient activation describes a person's knowledge, skills, and confidence to manage their own health, measurable with instruments such as the Patient Activation Measure.

Clinical relevance

Shared decision-making is regarded as a central element of patient-centred care, particularly for preference-sensitive decisions where the right choice depends on how a patient weighs benefits and harms. This entry describes the process and its supporting tools as reference material; it does not direct any specific clinical decision, which always depends on the individual patient and clinician.

Evidence & guidelines

A Cochrane systematic review by Stacey and colleagues found that patient decision aids improve patients' knowledge and accuracy of risk perception and help them make choices more consistent with their values. Barry and Edgman-Levitan describe shared decision-making as the pinnacle of patient-centred care, and the Patient Activation Measure (Hibbard and colleagues) provides a way to quantify patient engagement.

History

Following critiques of paternalistic medicine, Charles and colleagues (1997) gave shared decision-making an influential conceptual definition. Through the 2000s, patient decision aids were developed and tested, leading to cumulative Cochrane reviews (Stacey and colleagues), while Elwyn and colleagues (2012) provided a widely adopted three-step model for clinical practice and the concept of patient activation (Hibbard and colleagues, 2005) broadened the engagement agenda.

Debates

How much should decisions be shared?

Patients differ in how much they wish to participate, and shared decision-making must respect a patient's preferred role rather than impose participation; balancing professional recommendation with patient autonomy remains a central tension.

Key figures

• Cathy Charles
• Glyn Elwyn
• Dawn Stacey
• Michael Barry
• Judith Hibbard

Seminal works

• charles-1997
• elwyn-2012
• stacey-2017

Frequently asked questions

What makes a decision suitable for shared decision-making?

Decisions are especially suited to sharing when there is more than one reasonable option and the best choice depends on how the individual patient weighs the benefits and harms — so-called preference-sensitive decisions.

What is a patient decision aid?

A patient decision aid is a structured tool that presents the available options and their likely outcomes and helps patients clarify what matters most to them; systematic reviews find such aids improve knowledge and value-consistent choices.