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PERSPECTIVE
Shared Decision Making: A Model for Clinical Practice
Glyn Elwyn, PhD1,2, Dominick Frosch, PhD3,4, Richard Thomson, MD5,Natalie Joseph-Williams, MSc1, Amy Lloyd, PhD1, Paul Kinnersley, MD1, Emma Cording, MB BCh1, Dave Tomson, BM BCh6, Carole Dodd, MSc7, Stephen Rollnick, PhD1, Adrian Edwards, PhD1, and Michael Barry, MD8,9
1Cochrane Institute of Primary Care and Public Health, Neuadd Meirionydd, Cardiff University, Cardiff, UK; 2The Dartmouth Center for Health Care Delivery Science, Dartmouth College, New Hampshire, NH, USA; 3Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA; 4Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA;
5Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK; 6Collingwood Health Group, New York Surgery, North Shields, UK; 7Clinical Governance & Risk department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; 8General Medicine Division, Massachusetts General Hospital, Boston, MA, USA; 9Informed Medical Decisions Foundation, Boston, MA, USA.
The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice.Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting what matters most to patients as individuals, and that this exploration in turn depends on them developing informed preferences.
INTRODUCTION
Sharing decisions, as opposed to clinicians making decisions on behalf of patients, is gaining increasing prominence in health care policy.14 Shared decision making
(SDM) has been defined as: an approach where clinicians and patients share the best...