Shared decision making (SDM) is a process in which individuals and clinicians work together to understand and decide what tests, treatments, or support packages are most suitable bearing in mind a person’s own circumstances. It brings together the individual’s expertise about themselves and what is important to them together with the clinician’s knowledge about the benefits and risks of the options. This means that lay expertise is given the same value as clinical expertise.
SDM requires skill from professionals and most importantly a willingness to involve their patient in decisions about their care. It also needs recognition from those same professionals that patients, particularly those with lower levels of health literacy, may need support to take a more active partnership role with their care professional. To be successful, it relies on two sources of expertise:
- the health professional as an expert on the effectiveness, probable benefits and potential harms of treatment options; and
- the patient as an expert on themselves, their social circumstances, attitudes to illness and risk, values and preferences.
In any decision where there is more than one option, the values and preferences of the person, such as their attitude to risk, may be as important as the clinical evidence in choosing which option to follow.
Shared decision making enables patients to align their preferences to treatment options that are clinically valid. It does not mean that people can choose clinical treatments that have no evidence base.
Both parties must be willing to share information and accept shared responsibility for joint decision-making. This may only be a subtle change of practice for some, but it could feel like a dramatic one for others and for patients.
Shared decision making is now consistently quoted as a key tenet of modern healthcare but is too often still not fully practised by clinicians or experienced by patients. There can still be a disconnect between what clinicians think they are doing and what patients think clinicians are doing