Shared Decision-Making

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Shared Decision-Making in healthcare

Shared Decision Making (SDM) in healthcare, is the practice of communication between patient and the provider to achieve better outcomes. Shared decision-making has been called ‘the crux of patient-centred care', (Weston 2001).[1] SDM serves as a integral tool of the provider to achieve improved quality and safety in healthcare. The clinician’s learned processes that have lead to low adoption of SDM are changing as patients become more involved with their healthcare and providers become more aware of the achieved outcomes results that come with the practice of SDM.[2]

Why is Shared Decision-Making important? [3]
• Many clinical decisions involve value judgments
• Interventions have different benefits to risks that patients value differently
• There is no single right answer for everyone • Ethical principle of patient autonomy and legal requirements of informed consent
• Healthcare providers cannot automatically infer what patients value, nor can they assume what care decisions are in a patients' best interest.
• Evidence-based practice movement is increasing in healthcare
• Increasing realization that an important piece of evidence is missing without the patient’s perspective
• Uncertain nature of clinical information
• Patient-Centric care

Patients know more about their health and their lifestyle and their physical limitations and goals than what physicians have traditionally given them credit for, notes, states Howard J. Luks, MD.[4] SDM has the ability to assist the provider in obtaining useful qualitative information from their patients, which in-turn will lead to better outcomes.

Doctors must take the initiative with SDM, states Godolphin.[5] Trends are being reflective of change in medical education to patient-centered care. Movements toward the active involvement of patients as educators of health professionals also have the potential to change attitudes and health professional culture (Farrell et al. 2006.[6] The patient today is much more informed that even a few years ago. The patient’s growth in awareness can be attributed to their access of health information via the Internet. Isn’t an informed patient the fastest track to improve quality and outcomes?

Tool and links for SDM
Patient Decision Aids, Ottawa-
SDM toolkit, Dartmouth-Hitchcock Medical Center-
The Cochrane Collaboration-


 1. Informed and shared decision-making: the crux of patient-centred care Dr. Weston, Professor, University of Western Ontario, London, Ont.
 2. Healthcare Quarterly, 12(Sp) 2009: e186-e190 Understanding Decision-Making in Healthcare and the Law Shared Decision-Making William Godolphin
 3. Cornelia M. Ruland, RN, PhD, Columbia University, New York
 4. Howard J. Luks, MS,
 5. Understanding Decision-Making in Healthcare and the Law Shared Decision-Making William Godolphin
 6. Farrell, C., A. Towle and W. Godolphin. 2006. Where's the Patient's Voice in Health Professional Education? Vancouver, BC: University of British Columbia.

Submitted by Jeffrey L. Brandt