Shared decision making: a model for clinical practice

Glyn Elwyn, Dominick Frosch, Richard Thomson, Natalie Joseph-Williams, Amy Lloyd, Paul Kinnersley, Emma Cording, Dave Tomson, Carole Dodd, Stephen Rollnick, Adrian Edwards, Michael Barry, Glyn Elwyn, Dominick Frosch, Richard Thomson, Natalie Joseph-Williams, Amy Lloyd, Paul Kinnersley, Emma Cording, Dave Tomson, Carole Dodd, Stephen Rollnick, Adrian Edwards, Michael Barry

Abstract

The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting "what matters most" to patients as individuals, and that this exploration in turn depends on them developing informed preferences.

Conflict of interest statement

Glyn Elwyn and Adrian Edwards have developed a range of decision support interventions for patients, including AmnioDex, Prosdex and Bresdex (hosted by NHS Direct in the UK). Michael Barry, Adrian Edwards, Glyn Elwyn, Richard Thomson, Natalie Joseph-Williams are members of the IPDAS collaboration. Glyn Elwyn is a director of Prepare to Share, a consultancy group for shared decision making. Michael Barry receives salary support as president of the Informed Med Decis Making Foundation, a not-for-profit (501 (c) 3) organization. (http://www.informedmedicaldecisions.org). The Foundation develops content for decision support programs. The Foundation has an arrangement with a for-profit company, Health Dialog, to co-produce these programs. The programs are used as part of the decision support and disease management services Health Dialog provides to consumers through health care organizations and employers.

Figures

Figure 1.
Figure 1.
A shared decision making model.

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