Shared Decision-Making and Patient-Centered Communication

Shared decision-making is an approach in which clinicians and patients work together to make decisions about care, combining the clinician's knowledge of the options and their evidence with the patient's informed preferences and values. In medication communication it reframes counseling from a one-way transfer of instructions into a two-way deliberation about whether and how to use a medicine. This entry describes the concept, its principal models, and the communication that supports it.

Definition

Shared decision-making is a process in which a clinician and a patient jointly participate in making a health decision, exchanging information about the available options and their potential benefits and harms, and reaching a choice that reflects the patient's informed preferences.

Scope

The topic covers the definition and defining features of shared decision-making, the influential models that operationalize it (including option/decision/choice talk and integrative frameworks), and patient-centered communication as the broader style in which it sits. It is a conceptual and methodological account of how collaborative decisions are structured; it does not recommend particular treatment choices.

Core questions

• What distinguishes shared decision-making from informed consent and from paternalistic or purely informative styles?
• What stages or talk types make up the principal models of shared decision-making?
• What are the necessary ingredients — information exchange, deliberation, and a joint decision — of a shared decision?
• How does patient-centered communication support involving patients in decisions about their medicines?

Key concepts

• Patient preferences and values
• Information exchange and deliberation
• Option, decision, and choice talk
• Decision aids
• Equipoise and preference-sensitive decisions
• Patient-centered communication

Key theories

Charles, Gafni, and Whelan defining characteristics of shared decision-making

An early and influential analysis proposing that shared decision-making requires at least two participants (clinician and patient), that both share information, that both take steps to build a consensus about the preferred treatment, and that both agree on the decision to implement — distinguishing it from paternalistic and purely informed models.

Elwyn three-talk model

A practical model framing shared decision-making as a sequence of team talk (working together and offering support), option talk (comparing alternatives using risk communication), and decision talk (eliciting and integrating informed preferences), refined into a multistage consultation process.

Mechanisms

In a shared decision the clinician and patient first establish that a decision is to be made together, then review the reasonable options with their benefits and harms, often using structured risk communication or a decision aid, and finally elicit and incorporate the patient's informed preferences to reach a joint choice. Charles and colleagues specified the defining ingredients — two-way information sharing, deliberation toward consensus, and joint agreement — while Elwyn and colleagues translated these into the team-talk, option-talk, and decision-talk sequence intended for everyday consultations. The approach is most clearly indicated for preference-sensitive decisions, where more than one reasonable option exists and the best choice depends on how the patient weighs the trade-offs.

Clinical relevance

Shared decision-making describes how patients can be involved in decisions about their treatment, including whether and how to use medicines, and is frequently invoked as a marker of patient-centered care. As a reference topic it explains the concept and its models; it does not direct which option any individual should choose.

Evidence & guidelines

The literature on shared decision-making is largely conceptual and model-building, complemented by trials of decision aids that have shown improvements in patients' knowledge and accuracy of risk perception and reductions in decisional conflict, with more variable effects on which option is chosen. Commentary such as Barry and Edgman-Levitan frames shared decision-making as central to patient-centered care, while the models of Charles and of Elwyn provide the conceptual scaffolding most often cited.

History

Shared decision-making emerged in the 1990s as a response to both paternalistic and purely informative models of the clinical encounter, with Charles and colleagues' 1997 paper providing an early conceptual anchor. The 2000s and 2010s saw the concept operationalized into teachable models, notably Elwyn's three-talk model, and embedded in policy as an expression of patient-centered care, extending from physician encounters into pharmacy and other settings.

Debates

How far should shared decision-making extend across decisions?

It is most clearly suited to preference-sensitive decisions where reasonable options differ in their trade-offs; whether and how to apply it to decisions with a clear evidence-based best option, or when patients prefer the clinician to decide, remains debated.

Key figures

• Cathy Charles
• Glyn Elwyn
• Gregory Makoul
• Michael Barry

Seminal works

• charles-1997
• elwyn-2012
• makoul-2006

Frequently asked questions

How is shared decision-making different from informed consent?

Informed consent ensures a patient is told about and agrees to a proposed intervention, whereas shared decision-making involves deliberating together over the reasonable options and reaching a choice that reflects the patient's informed preferences — a more collaborative and two-way process.

What are the three talks in Elwyn's model?

Team talk (agreeing to work together and offering support), option talk (comparing the alternatives and their risks and benefits), and decision talk (eliciting and integrating the patient's informed preferences to reach a decision).