Shared Decision-Making. A Primer for Clinicians
Journal of General Internal Medicine, vol. 40, pp. 3889–3899
Abstract
IMPORTANCE: Shared decision-making is a widely promoted approach, yet clinicians, typically supportive in principle, find it difficult to implement because of concerns and barriers they commonly encounter in practice. OBJECTIVE: To generate a primer that describes shared decision-making from the perspective of clinicians. METHODS: We collaborated with clinicians, patient representatives, and health service researchers. We invited members of the International Society of Shared Decision Making to co-produce a primer for clinicians using a series of jointly edited online documents. We shared drafts with other clinicians and patients. Finally, we integrated the contributions until we had arrived at a consensus. FINDINGS: Twenty-five people from 13 countries contributed; 9 had medical qualifications, 4 had nursing qualifications, and 12 others had a range of backgrounds. A total of 30 patients and clinicians provided further comments. The description differs from previous versions because it addresses the barriers that clinicians frequently mention. It describes how to overcome common challenges by emphasizing the importance of a clear invitation at initiation; it suggests how to manage patients' resistance to shouldering decisional responsibility; reinforces the need to allow time for deliberation, especially with other stakeholders; and reassures clinicians that consensus, albeit welcome, need not be the goal of shared decision-making. CONCLUSIONS AND RELEVANCE: This primer portrays a reflective clinician who is aware of power asymmetry, patient vulnerability, risk communication, health literacy, agenda setting, and goal clarification. It envisages a clinician who is curious about personal perspectives and who can offer collaborative, iterative, and deliberative steps.
Authors 26
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Glyn Jones Elwyn corresponding
Dartmouth College · Dartmouth Institute for Health Policy and Clinical Practice
Affiliation as printed
The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, WTRB, Lebanon, NH, USA. glynelwyn@gmail.com
The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, WTRB, Lebanon, NH, USA
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University of Oslo · Akershus University Hospital
Affiliation as printed
Institute of Clinical Medicine, University of Oslo, HØKH Health Services Research Unit, Akershus University Hospital, and Senior Researcher, Nordbyhagen, Norway
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Dartmouth College · Dartmouth Institute for Health Policy and Clinical Practice
Affiliation as printed
The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, WTRB, Lebanon, NH, USA
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Affiliation as printed
Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
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United States Department of Veterans Affairs · Veterans Health Administration
Affiliation as printed
Center for Health Organization and Implementation Research (CHOIR), Veterans Health Administration, Washington, DC, USA
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Affiliation as printed
Division of Population Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
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Affiliation as printed
Department of Medicine and Nephrology, Aarhus University, Aarhus, Denmark
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Affiliation as printed
eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
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Affiliation as printed
Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA
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University Medical Center Hamburg-Eppendorf
Affiliation as printed
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Affiliation as printed
Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
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Taipei Medical University Hospital · Taipei Medical University
Affiliation as printed
Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei City, Taiwan
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Affiliation as printed
Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Pamplona, Spain
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Affiliation as printed
Department of Anaesthesia, Perioperative Medicine and Pain Medicine. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Affiliation as printed
Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, HKSAR, China
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University Hospital of North Norway
Affiliation as printed
Centre for Shared Decision Making, University Hospital of North Norway, Tromsø, Norway
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University of Wisconsin–Madison
Affiliation as printed
School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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University of Oslo · Leiden University Medical Center
Affiliation as printed
Faculty of Medicine, University of Oslo, Oslo, Norway
Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
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Affiliation as printed
Dartmouth Health, Lebanon, NH, USA
Dartmouth Health, Lebanon, NH, USA
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Affiliation as printed
Faculty of Health and Sport Science, Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
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Hospital Italiano de Buenos Aires
Affiliation as printed
Family and Community Medicine Department Hospital Italiano de Buenos Aires, Perón, Buenos Aires, Argentina
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Affiliation as printed
Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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University Hospital Schleswig-Holstein
Affiliation as printed
National Competency Center for Shared Decision Making, University Medical Center Schleswig-Holstein, Kiel, Germany
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Affiliation as printed
Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Affiliation as printed
Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Victor Phillip Dahdaleh Heart and Lung Research Institute, Cambridge, UK
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Affiliation as printed
Informed Medical Decisions Foundation, Boston, MA, USA
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