Shared decision-making as a method of care

Care happens in interaction between the patient and the clinician, in conversation where the patient and clinician uncover or develop a shared understanding of the problematic situation of the patient and identify, discover, or invent ways to make that situation better, given what each patient prioritises and seeks.1 Thus, to get the right care for each patient, patient and clinician collaborate and deliberate together to figure out what to do.2 Shared decision-making (SDM) has been traditionally defined as a collaborative approach by which, in partnership with their clinician, patients are encouraged to think about the available care options and the likely benefits and harms of each, to communicate their preferences, and help select the best course of action that fits these.3 This definition is limited to situations in which the problem and the pertinent options to address it can be defined a priori, and the main task is to find the option that best matches the patient’s preferences. Thought in this way, SDM may involve distributing decision aids for patients to come prepared for the consultation and using tools to elicit and document patient preferences. This practice has been proposed as an expression of patient-centred care, a way of involving patients, an antidote to medical paternalism, and as a way to promote high-value care.3 But anytime, a patient and clinician figure out together what to do about the patient’s situation, they are doing SDM. Although there are multiple models and accounts of what SDM is and is not,2 4 5 in practice, SDM starts by determining the nature of the problematic situation the patient is experiencing. This often requires considering insights that only the patient and perhaps their family can share, insights about both the patient’s biology and biography. Then clinicians must mobilise their competence …