Shared decision making: Concepts, evidence, and practice

A M Stiggelbout; A H Pieterse; J C J M De Haes

doi:10.1016/j.pec.2015.06.022

Shared decision making: Concepts, evidence, and practice

Patient Educ Couns. 2015 Oct;98(10):1172-9. doi: 10.1016/j.pec.2015.06.022. Epub 2015 Jul 15.

Authors

A M Stiggelbout¹, A H Pieterse², J C J M De Haes³

Affiliations

¹ Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.m.stiggelbout@lumc.nl.
² Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.

PMID: 26215573
DOI: 10.1016/j.pec.2015.06.022

Abstract

Objective: Shared decision-making (SDM) is advocated as the model for decision-making in preference-sensitive decisions. In this paper we sketch the history of the concept of SDM, evidence on the occurrence of the steps in daily practice, and provide a clinical audience with communication strategies to support the steps involved. Finally, we discuss ways to improve the implementation of SDM.

Results: The plea for SDM originated almost simultaneously in medical ethics and health services research. Four steps can be distinguished: (1) the professional informs the patient that a decision is to be made and that the patient's opinion is important; (2) the professional explains the options and their pros and cons; (3) the professional and the patient discuss the patient's preferences and the professional supports the patient in deliberation; (4) the professional and patient discuss the patient's wish to make the decision, they make or defer the decision, and discuss follow-up. In practice these steps are seen to occur to a limited extent.

Discussion: Knowledge and awareness among both professionals and patients as well as tools and skills training are needed for SDM to become widely implemented.

Practice implications: Professionals may use the steps and accompanying communication strategies to implement SDM.

Keywords: Deliberation; Medical ethics; Patient preferences; Physician-patient communication; Shared decision making.

MeSH terms

Communication*
Decision Making*
Decision Support Techniques
Delivery of Health Care
Health Services Research
Humans
Patient Participation*
Patient Preference
Physician-Patient Relations*