Potential Unintended Consequences Of Recent Shared Decision Making Policy Initiatives

Health Aff (Millwood). 2019 Nov;38(11):1876-1881. doi: 10.1377/hlthaff.2019.00243.


Shared decision making (SDM)-when clinicians and patients make medical decisions together-is moving swiftly from an ethical ideal toward widespread clinical implementation affecting millions of patients through recent policy initiatives. We argue that policy initiatives to promote SDM implementation in clinical practice carry the risk of several unintended negative consequences if limitations in defining and measuring SDM are not addressed. We urge policy makers to include prespecified definitions of desired outcomes, offer guidance on the tools used to measure SDM in the multitude of contexts in which it occurs, evaluate the impact of SDM policy initiatives over time, review that impact at regular intervals, and revise SDM measurement tools as needed.

Keywords: Cancer patients; Health policy; Medical research; Quality of care; Shared decision making; ethics; patient engagement; public health.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making, Shared*
  • Delivery of Health Care*
  • Humans
  • Organizational Policy*
  • Patient Participation*