When and where is shared decision making appropriate?

Shared Decision Making (SDM) is appropriate in almost every situation in community, primary and secondary care where a care decision has to be made and that decision is said to be “preference sensitive.”

For example:

  • in any case where there is more than one reasonable course of action and the decision involves trade-offs e.g. length of life v. quality of life
  • where there is uncertainty or unclear evidence for one option over another
  • where the options have different inherent risks or benefits or where individual values are important in optimising the decision.

This applies to most decisions in healthcare and, more often than not, it is appropriate to use shared decision making. This is even the case in some accident and emergency settings, including chest pain and stroke.

Process mapping and decision point mapping can help determine where to start shared decision making conversations and in some cases, decision point maps are already available.