Shared decision making
Shared decision-making is an approach where clinicians and patients communicate together using the best available evidence when faced with the task of making decisions, where patients are supported to deliberate about the possible attributes and consequences of options, to arrive at informed preferences in making a determination about the best action and which respects patient autonomy, where this is desired, ethical and legal.

One of the first instances where the term ‘shared decision making’ was used was in a report entitled the ‘President's Commission for The Study of Ethical Problems in Medicine and Biomedical Research. This work built on the increasing interest in patient-centredness and an increasing emphasis on recognising patient autonomy in health care interactions since the 1970s.

Charles described a set of principles for shared decision making, stating “that at least two participants, the clinician and patient be involved; that both parties share information; that both parties take steps to build a consensus about the preferred treatment; and that an agreement is reached on the treatment to implement". These principles rely on an eventual arrival at an agreement but this final principle is not fully accepted by others in the field. The view that it is acceptable to agree to disagree is also regarded as an acceptable outcome of shared decision making.

Elwyn described a set of competences for shared decision making, which are composed of the steps of defining the problem which requires a decision, the portrayal of equipoise and the uncertainty about the best course of action, thereby leading to the requirement to provide information about the attributes of available options and support a deliberation process. An assessment scale to measure the extent to which clinicians involve patients in decision making has been developed and translated into Dutch, Chinese, French, German, Spanish and Italian (Option Instrument).

Many researchers and practitioners in this field meet every two years in the International Shared Decision Making Conference, which have been held at Oxford in 2001, Swansea 2003, Ottawa 2005, Freiburg 2007, Boston in 2009, and Maastricht in 2011. The next conference is scheduled to be in Peru in 2012. Shared decision making is also closely associated with the use of decision support interventions, also known as decision aids
Decision aids
Decision aids is the name commonly used to describe interventions that are designed for patients, or people facing healthcare decisions. They are used to facilitate shared decision making...

. Much of the research and implementation studies to date are contained in the following publication: Shared Decision Making in Healthcare: Evidence-based Patient Choice. 2nd ed. Oxford: Oxford University Press, 2009.

In December 2010 a Salzburg Global Seminar focused on "The Greatest Untapped Resource in Healthcare? Informing and Involving Patients in Decisions about Their Medical Care." Powerful conclusions emerged among the 58 participants from 18 countries: not only is it ethically right that patients should be involved more closely in decisions about their own medical care and the risks involved, it is practical – through careful presentation of information and the use of decision aids/pathways – and it brings down costs. Unwarranted practice variations – where one area may have many more interventions than another, but with no better outcomes – are reduced, sometimes dramatically. So why is it that this ‘win-win’ approach is not better understood? Following the seminar the participants created the Salzburg Statement on Shared Decision Making launched in London by the BMJ, one of the world’s leading medical journals, and released to the press worldwide to stimulate attention and debate..

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