Shared Decision-Making

Shared decision-making is a process in which clinicians and patients make health decisions together, combining the clinician's knowledge of the evidence with the patient's values and preferences. It is most relevant when there is more than one reasonable option and the best choice depends on what matters to the patient, and it is often supported by patient decision aids.

Definition

Shared decision-making is a collaborative process in which patients and clinicians make health decisions together, integrating the best available evidence with the patient's informed preferences and values.

Scope

This topic covers the concept and models of shared decision-making, the role of patient decision aids, and the barriers to putting it into routine practice. It is a reference topic describing how shared decision-making is defined, modelled, and studied, not guidance for making any specific clinical decision.

Core questions

• When is shared decision-making most appropriate?
• What steps or components define the process?
• How do patient decision aids support it?
• What barriers limit its adoption in routine care?

Key concepts

• Preference-sensitive decisions
• Patient decision aids
• Option talk and decision talk
• Informed preferences
• Equipoise
• Patient values
• Implementation barriers

Key theories

Three-talk model of shared decision-making

Elwyn and colleagues described shared decision-making as a sequence of team talk (presenting options and offering support), option talk (comparing alternatives), and decision talk (eliciting and integrating informed preferences), offering a practical structure for the process.

Mechanisms

Shared decision-making works by structuring the encounter so that the patient understands the available options and their trade-offs and contributes their values to the choice. Models such as the three-talk approach describe presenting options, deliberating over their benefits and harms, and reaching a preference-based decision. Patient decision aids support this by presenting balanced evidence and helping patients clarify what matters to them. The approach is especially suited to preference-sensitive decisions, where reasonable options differ in ways that depend on patient values rather than on evidence alone.

Clinical relevance

Shared decision-making describes how patients and clinicians can make preference-sensitive choices together and is part of patient-centred care. This entry characterizes the process and its evidence base as reference material; it does not direct any particular decision, which depends on the patient's situation and values.

Epidemiology

Shared decision-making is relevant across many preference-sensitive areas of care, including screening choices, treatment options for chronic conditions such as diabetes, and elective procedures, where the right choice often varies between similar patients with different priorities.

Evidence & guidelines

Models such as the three-talk approach (Elwyn et al., 2012) and analyses of key elements and barriers (Légaré & Witteman, 2013) describe how shared decision-making is meant to work, while systematic review of professionals' perceptions identifies recurrent barriers and facilitators to implementation (Légaré et al., 2008). Adoption into routine practice remains incomplete, and findings are presented descriptively rather than as practice direction.

History

Shared decision-making emerged from work in the 1990s, including the conceptual analyses of Charles and colleagues, as a middle path between paternalistic and purely informed-choice models of the clinical encounter. Models such as the three-talk framework of Elwyn and colleagues (2012) gave it practical structure, and a substantial literature, including the reviews of Légaré and colleagues, has since examined the persistent gap between its endorsement and its routine use.

Debates

Why is shared decision-making hard to adopt in routine care?

Despite broad endorsement, implementation lags because of barriers such as time constraints, clinician attitudes, and workflow fit; systematic review of professionals' perceptions catalogues these recurrent barriers and facilitators.

Key figures

• Glyn Elwyn
• France Légaré
• Victor Montori
• Cathy Charles

Seminal works

• elwyn-2012
• legare-2008

Frequently asked questions

When is shared decision-making most useful?

It is most useful for preference-sensitive decisions, where there is more than one reasonable option and the best choice depends on the patient's values and priorities rather than on the evidence alone.

What is a patient decision aid?

A patient decision aid is a tool that presents balanced information about the options, including their benefits and harms, and helps patients clarify what matters to them so they can participate in the decision.