Policy and practice developments in the implementation of shared decision making: an international perspective

Abstract

Shared decision making (SDM) was first mentioned as a term in 1982 in the USA in a report of the President's Commission [ [1] President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Washington, DC: President's Commission; 1982. Google Scholar ]. Charles and colleagues [ [2] Charles C. Gafni A. Whelan T. Shared decision-making in the medical encounter: wht does it mean? (or it takes at least two to tango). Soc Sci Med. 1997; 44: 681-692 Crossref PubMed Scopus (2746) Google Scholar ] stimulated more conceptual clarity about shared decision making: the SDM process is most relevant where there are important decisions to be made at key points in disease process, where several competing treatment options may exist with different beneficial outcomes and risks or undesired side-effects, and where uncertainty may exist. Some variation has been noticed in the way that SDM has been described over the last 30 years [ [3] Makoul G. Clayman M. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006; 60: 301-312 Abstract Full Text Full Text PDF PubMed Scopus (989) Google Scholar ] – but in essence – the concept is easy to grasp – it is about involving the patients in the process of making decisions where there are important reasonable competing options, often with “watchful waiting” as one of the valid options. Building on the many conceptual debates, the following definition is offered as a way of bringing together the main elements: ‘Shared decision making is an approach where clinicians and patients make decisions together using the best available evidence. Patients are encouraged to think about the available screening, treatment, or management options and the likely benefits and harms of each so that they can communicate their preferences and help select the best course of action for them. Shared decision making respects patient autonomy and promotes patient engagement [ [4] Elwyn G. Leitner S. Coulter A. Walker E. Watson P. Thomson R. Implementing shared decision making in the NHS. BMJ. 2010; 341: c5146 Crossref PubMed Scopus (584) Google Scholar ].’