Shared decision-making
- Technique
When there is more than one reasonable option, patient and clinician compare them and choose together according to the patient's values.
What it is
Shared decision-making is a communication process in which the clinician brings the evidence on options, benefits and harms, and the patient brings their values, preferences and circumstances. It is most useful in preference-sensitive decisions, where no option is clearly better. A widely used scheme splits it into three conversations: introducing the choice, describing the options and reaching the decision. The ethical and legal aspects of consent are covered in another section.
Key facts
- Typical examples: prostate cancer screening with prostate-specific antigen, breast-conserving surgery versus mastectomy in early breast cancer, options in chronic disease.
- Shared decision-making sits between paternalism and the purely informative model, close to Emanuel's deliberative model.
- Greater physician empathy goes with more shared decision-making and less regret.
- Barriers: time, low health literacy, language and cultural differences, and the clinician's belief that the patient does not want to take part.
How it is done
- Introduce the choice: ‘There is more than one reasonable way forward, and your view matters’.
- Ask what they know and how much they want to be involved in the decision.
- Describe each option, including watchful waiting, with benefits and harms in absolute numbers.
- Use a decision aid if one exists (leaflet, icon array, comparison table).
- Explore values: ‘What matters most to you in choosing?’
- Check understanding with teach-back.
- Decide together, or agree a time frame to decide and whom to consult.
- Revisit the decision at follow-up.
Test yourself
Think of the answer, then tap the question to see it.
When is shared decision-making especially indicated?
When there are several reasonable options with none clearly better, and the choice depends on the patient's values and preferences.
What are the three conversations of the most used model?
Introducing that there is a choice, describing the options with their benefits and harms, and reaching the decision.
What effect do decision aids have?
They increase knowledge, make risk perception more accurate and reduce decisional conflict.
Why are risks given as absolute numbers?
They are easier to understand and do not exaggerate the effect as relative risk does; for example, ‘2 in 100 versus 1 in 100’.
Elsewhere in DurgiPedia
Connections
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Communication in Cancer Care (PDQ®)–Health Professional Version (National Cancer Institute (US), 2025); Talking With Your Doctor: MedlinePlus (National Library of Medicine (US), 2025).
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Representative model, for educational purposes only.