Shared decision making is a collaborative process in which patients are supported by their healthcare professional to select which of the available options they wish to choose. It brings together in the consultation, or conversations the best scientific evidence and the patient’s values and preferences - which themselves are informed by their beliefs, personal constructs and their personal circumstance, including their age, family and social relationships etc.
It occupies the middle ground between more traditional clinician-centred practice, where patients rely on their doctor or healthcare professional to make decisions about their care, and consumerism, where patients are given information and then left to make their own choices.
Clinicians have access to knowledge about the treatment options, their risks and benefits, while patients have knowledge on what is important to them, their own goals and preferences. Good shared decision making recognises these different contributions and brings these complementary areas of expertise together, leading to better quality decisions.
Shared decision-making can take place between a patient, with or without their family, and any of the healthcare professionals involved in their treatment and care, from their health visitor at home to their GP or practice nurse in a primary care setting, to consultations with a surgeon, specialist nurse, psychologist or physiotherapist in hospital.
It is relevant at any decision point along the patient’s care pathway and is particularly relevant where reasonable options and choices are available, including the choice to do nothing. Reasonableness needs to be understood in terms of both the individual's goals and efficacy of an intervention.
Common examples of where it is used include decisions about:
- undergoing screening or a diagnostic test
- different medical or surgical procedures
- self-management of a long-term condition
- participation in a psychological intervention
- making a change in lifestyle
- taking medication.
Shared decision making may not be appropriate for all clinical circumstances, for example in a life threatening emergency or where a patient lacks the capacity to engage. In predictable clinical situations decisions may be shared in advance, for example whether or not to resuscitate.
To be effective, shared decision making requires:
- Patients who feel confident and empowered to play an active role in decisions about their care.
- Healthcare professionals who are skilled in using shared decision making approaches and tools and in managing the dynamics of shared decision making.
- Organisational processes and tools that support shared decision making.