070 Shared decision making: a definition for clinicians
Abstract
Introduction Shared decision-making has been adopted at policy levels yet its definition and implementation are debated in clinical practice. We aimed to generate a definition that views shared decision-making from the perspective of clinicians, and the work they need to accomplish it, by addressing some of the most commonly voiced hurdles. Methods We initiated a collaborative process by inviting members of the International Society of Shared Decision-Making to coproduce a definition for clinicians using a series of collaborative documents and then involved a wider group of clinicians and patients. Results The definition generated by this collaboration differs from previous work because it addresses the barriers that frequently concern clinicians. It describes rather than prescribes how clinicians might tailor the approach to fit their work. It emphasizes the importance of a clear invitation and a careful justification when initiating the process; it provides a way to manage the common patient resistance to shouldering decisional responsibility, acknowledges uncertainty, reinforces the need to allow time for deliberation, especially with other stakeholders, and reassures that consensus, albeit welcome, need not be the goal of shared decision-making. Conclusions and Relevance The definition portrays a reflective clinician, aware of power asymmetry, patient vulnerability, distributed actor involvement, risk communication, health literacy, agenda setting, and goal clarification: a capable communicator with curiosity about personal perspectives, who offers iterative deliberative steps. Established clinicians may find it challenging to prioritize a deeper understanding of patients’ perspectives. The in-the-moment cognitive flexibility required to adopt a different form of dialogue may be an unwelcome new burden. Shared decision- making is unlikely to take less time, nor will it make practice any easier: on the other hand, it could bring more variety and a definite need for mindful judgment. The possibility that deeper dialogue might bring joy and less burnout is worth evaluating.
Authors 26
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Dartmouth Institute for Health Policy and Clinical Practice
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Coproduction Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA
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Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Dartmouth Institute for Health Policy and Clinical Practice
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Coproduction Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA
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Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia
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United States Department of Veterans Affairs · Veterans Health Administration · Center for Health Optimization and Implementation Research
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Center for Health Organization and Implementation Research (CHOIR), Veterans Health Administration, DC, USA
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Division of Population Medicine, Cardiff University, Cardiff, UK
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Department of Medicine and Nephrology, Aarhus University, Aarhus, Denmark
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CentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
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Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA
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University Medical Center Hamburg-Eppendorf
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Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia
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Department of Physical Medicine and Rehabilitation, Taipei, Taiwan
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Department of Community, Maternity and Pediatric Nursing, University of Spain, Pamplona, Spain
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Department of Anaesthesia, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Victoria, Australia
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Department of Social and Behavioural Sciences, City University of Hong Kong, HKSAR, China
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University Hospital of North Norway
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Centre for Shared Decision Making, University Hospital of North Norway, Tromsø, Norway
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University of Wisconsin–Madison
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School of Nursing, University of Wisconsin-Madison, Madison, USA
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Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical, Leiden, Netherlands
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Faculty of Health and Sport Science, University of Agder, Oslo, Norway
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Hospital Italiano de Buenos Aires
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Family and Community Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires Argentina
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Division of Medical Oncology, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
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University Hospital Schleswig-Holstein
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National Competency Center for Shared Decision Making, University Medical Center Schleswig-Holstein, Kiel, Germany
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Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
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Cardiovascular Epidemiology Unit, Cambridge Biomedical Campus, Cambridge UK
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Massachusetts General Hospital
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Department of General Internal Medicine, Massachusetts General Hospital, Boston, USA
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Informed Medical Decisions Foundation, Boston, USA
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