Six simple steps to shared decision making

Shared decision making may sound complicated, but it is simply a way for physicians to help patients select the optimal test or treatment among several valid options. These conversations involve six basic steps:

1. Invite the patient to participate: “Would you be willing to talk about breast cancer screening today?”

2. Present the options: “For breast cancer screening, women your age can choose to get a mammogram or not.”

3. Provide information on benefits and risks: “Among 1,000 women your age who undergo screening every year, about 21 are diagnosed with breast cancer and three die. About 600 have false alarms, and 124 undergo a biopsy.” An online decision aid such as HealthDecision(www.healthdecision.org) can be helpful with this step.

4. Assist the patient in evaluating options based on individual goals and concerns: “What do you think about the information I just shared? Do you have any concerns or preferences?”

5. Facilitate deliberation and decision making: “What I’m hearing is that, despite the risks, getting a mammogram will reassure you that you don’t have breast cancer.”

6. Assist the patient in following through on the decision: “I’ll go ahead and order the mammogram, and next year we can talk about how often you want to continue getting a mammogram.”

Adapted from “A Simple Approach to Shared Decision Making in Cancer Screening.”