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Correspondence on ‘The limits of shared decision making’ by Elwyn et al: We call for a more nuanced approach
  1. Nadine Ijaz1,2,
  2. L Susan Wieland3,
  3. Daniel F Gallego-Pérez4
  1. 1 Department of Law & Legal Studies, Carleton University, Ottawa, Ontario, Canada
  2. 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
  4. 4 Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Nadine Ijaz, Department of Law & Legal Studies, Carleton University, Ottawa, ON K1S 5B6, Canada; nadine.ijaz{at}

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We read with interest the recent article by Elwyn and colleagues that addressed ‘The limits of shared decision making’ (Elwyn et al, p.1).1 Like the article’s authors, we identify as ‘strong advocates of shared decision-making (SDM)’ while recognizing some limits to its application (Elwyn et al, p.1).1 However, we find the article’s interpretation of SDM principles to be lacking in nuance on multiple fronts.

SDM is an essential component of evidence-based medicine, which requires a ‘recognition that values and preferences are as important as evidence in determining optimal clinical decisions’ (Djulbegovic and Guyatt, p.194).2 SDM is at odds with unwanted paternalistic care, including clinical interactions wherein healthcare professionals may …

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  • Contributors NI: Conceptualisation; writing—original draft. LSW and DFG-P: Conceptualisation; writing—review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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