What is shared decision making?

Shared decision making is "a process in which the patient and clinician together reach an informed decision about the plan of care on the basis of the patient's clinical needs, priorities, and values" (Stacey et al BMJ 2008, p.954). The key features of shared decision making are:

  • Recognition by patient and provider that there is a decison to be made
  • Discussion of options
  • Discussion of benefits and harms of each option
  • Discussion of the patients' goals and concerns
  • Matching treatment with patients' informed preferences

To do this well often requires tools, such as risk calculators and patient decision aids, to synthesize the evidence and make it accesible to providers and patients at the point of care. It is also important to have clear measures of decision quality to assess the extent to which this is happening.

What is decision quality?

For situtaions where there is more than one clinically appropriate option for testing or treatment, we define decision quality as the extent to which patients are informed and receive tests or treatments that reflect their goals (Sepucha et al Health Affairs 2011).

Sometimes when patients are diagnosed with a medical condition there is only one appropriate treatment option. Surgery for treatment of hip fracture and antibiotics for treatment of bacterial meningitis are two examples of "effective care decisions." In these situations, the quality of decisions can be measured by the percentage of eligible patients receiving effective care. Many common decisions do not fall into this category of effective care. Instead there are multiple options available that require tradeoffs between benefits and harms. To understand the quality of a decision, we need to examine whether the right patient is being matched with the right treatment.

Decision quality, in these situations, involves assessing the extent to which treatments match the goals of informed patients.

What are Patient Decision Aids?

Patient Decison Aids (PtDAs) are tools that present options and outcomes and help patients consider their goals and treatment preferences. These tools have been shown to increase patient knowledge, help patients make a choice and reduce their decisional conflict (Stacey et al Cochrane Database Syst Rev 2011). At Mass General we have been using PtDAs developed by the Informed Medical Decisions Foundation and Health Dialog, Inc. Most of the decision aids are a DVD and booklet that feature interviews with patients, who have had the different treatment options, discussing their experiences.

Our Research Home Page

Other resources

Informed Medical Decisions Foundation

The John D. Stoeckle Center for Primary Care Innovation

Ottawa Health Research Institute

International Patient Decision Aid Standards (IPDAS) Collaboration

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