Shared decision making (SDM) — a collaborative process in which clinicians and patients work together to make healthcare decisions that are both evidence-based and aligned with the patient’s values, preferences, and life circumstances — is widely recognized as the ethically and clinically appropriate approach to medical decisions where multiple legitimate options exist. Despite its recognized importance, shared decision making is inconsistently practiced — many patients receive treatment without adequate information or opportunity to express their preferences. This guide explains shared decision making and how to participate in it effectively.
When Shared Decision Making Is Most Important
SDM is most valuable for “preference-sensitive” decisions — where there are multiple medically reasonable options with different risk-benefit profiles that align differently with different patients’ values: cancer treatment choices (surgery vs. radiation vs. active surveillance for prostate cancer), end-of-life care preferences, contraception methods, management of early-stage chronic conditions where lifestyle vs. medication approaches are both reasonable, or surgical decisions with significant complication risk. SDM is less applicable to clear-cut situations where one option is demonstrably superior.
The SDM Process
Effective SDM involves three steps. First — the clinician shares the diagnosis, available options, and the evidence-based benefits and harms of each option in terms the patient can understand. Second — the patient shares their values, preferences, concerns, and life context that are relevant to the decision. Third — together, they deliberate and agree on a decision that incorporates both the medical evidence and the patient’s individual context. Decision aids — written, electronic, or video materials describing options in patient-accessible terms — support this process outside the clinical encounter.
How to Participate in Shared Decision Making
Know that you have the right to understand your options and to have your preferences respected. Ask specifically: “What are my options?” and “What would happen if I chose each of these?” Express your preferences and concerns: “I’m most worried about X” or “I value Y more than Z.” Take time when decisions are not urgent — major decisions deserve reflection, consultation with family, and sometimes second opinions. Bring decision aids or patient information materials if helpful.
Conclusion
Shared decision making produces better outcomes — not because it changes the clinical evidence, but because patients who make decisions aligned with their own values are more likely to adhere to treatment, experience less decisional regret, and feel more satisfied with their care. Your preferences and values matter medically — they should inform your treatment plan, not simply be incorporated as an afterthought.
FAQs – Shared Decision Making
Q1. What if I disagree with my doctor’s recommendation?
A: Express your disagreement explicitly and ask the provider to explain the reasoning again. Ask what risks you accept by choosing differently. A second opinion is appropriate for major decisions. You have the right to decline recommended treatments — the clinician’s role is to ensure you understand the implications of your decision, not to override it.
Q2. What are patient decision aids?
A: Decision aids are evidence-based patient education tools describing specific clinical situations, the available options, and their benefits and harms in accessible terms — helping patients clarify their values and preferences before making decisions. The Ottawa Hospital Research Institute provides a searchable inventory of evidence-based decision aids (decisionaid.ohri.ca).
Q3. Is shared decision making always appropriate?
A: Not for all clinical situations. Emergency decisions where delay is dangerous, situations where one option is clearly superior based on strong evidence, and patients who explicitly prefer clinician-directed decision making all represent appropriate exceptions to standard shared decision making practice. SDM is most appropriate for preference-sensitive decisions where multiple options are medically reasonable.
Q4. How do I express my values and preferences to my doctor?
A: Articulate what matters most to you: “I want to avoid surgery if at all possible” or “Side effects that affect my work are a bigger concern for me than this medication’s effectiveness.” Tell your provider what you are most afraid of and what trade-offs you are and are not willing to make. This information is as clinically relevant as your symptoms.
Q5. What if I don’t understand the options well enough to choose?
A: Ask for more time, more information, or decision aid materials. Request a follow-up appointment specifically to discuss the decision after you have had time to review information and perhaps consult family members or support people. Ask which option your provider would recommend for someone with your specific values and circumstances — this often helps clarify the decision without removing your choice.
