A Simplified Model for Shared Decision Making

Editor's note: Case 1 below was edited to clarify that John chose the FIT-DNA test.

Shared decision making (SDM) is an essential component of modern primary care. At its most basic, SDM is a communication strategy in which the clinician informs the patient that they have a choice about a screening or treatment, the patient tells the clinician their thoughts about the options, and the two make a decision together about how to proceed. The bidirectional nature of the conversation is what makes it unique: The clinician provides knowledge of the scientific evidence, makes a recommendation, describes potential risks and benefits, and then asks the patient about their preferences, values, and goals. This sharing of decision making is relatively new in medical care and is an improvement over the previous process in which the clinician made a recommendation and hoped that the patient followed it.

Data suggests that when clinicians use SDM, patients are more knowledgeable about their health decisions, more confident in specific decisions they make, and more likely to adhere to the plan.¹ (See “Why use shared decision making?”)

SDM obviously does not work for medical emergencies or situations when there is one clear best medical decision (e.g., insulin for diabetic ketoacidosis or antibiotics for sepsis). But for a broad range of decisions, where there is no clear “right” answer or there is more than one medically reasonable option, SDM is important.

Research has shown that SDM does not have to be time-consuming to be effective. It can be performed in about 2.5 minutes even when discussing complex decisions such as whether to have surgery.² This article provides a simplified model for SDM, resources to help patients make decisions, and three case studies to show how the model works.