Shared Decision Making
State of the Science
Patients have traditionally entrusted decision making to physicians. However, during the past several decades, patients have been encouraged to become more activated and involved in their health decisions. These situations abound in cardiology, for example, therapy for stable coronary artery disease, anticoagulation for atrial fibrillation, and placement of implantable cardioverter-defibrillators. Each condition demands patient participation in the decision-making process because patients live with the consequences of medical decisions in their day-to-day lives. Unfortunately, research has also shown that patients often are misinformed about the risks and benefits associated with treatments and have little involvement in the decision-making process.1,2 Thus, 1 of the great challenges of increasing patient engagement is ensuring that patients make informed, evidence-based decisions that are consistent with their values and preferences.
Shared decision making (SDM) has come to the forefront as a way to improve clinical care for patients by encouraging the production and dissemination of accurate, balanced, understandable health information and increasing patient participation in care. SDM interventions have been shown to improve patients’ understanding of the available treatment options, increase the proportion of patients with realistic expectations of benefits and harms, stimulate patients’ involvement in decision making, and improve agreement between patients’ values and treatment choices.3 Incorporating patient preferences into the decision-making process may also lead to improved patient well-being through better adherence to treatment, fewer concerns about illness, and higher satisfaction with health outcomes.4,5
In this article, we review the state of the science in the field of SDM. We discuss models of SDM, as well as methods for providing decision support to patients, including best practices for risk communication, efficacy of decision aids (DAs) for decision support, and use of decision coaches to facilitate shared decision making.
Models of SDM
SDM was first invoked by the President’s Commission for …