Shared decision-making (SDM) integrates clinical evidence with patient preferences in established healthcare systems. More and more countries are focusing on the role of SDM in clinical settings and specific implementation strategies. However, the global distribution of research on SDM is extremely unequal, and there are also significant differences in the perception of SDM across regions and cultures. Therefore, it is necessary to discuss in depth the East-West differences of SDM in the hope of laying the foundation for future global SDM development in an equitable manner. In this analysis, we discuss cultural differences in SDM in a broad sense: the development of SDM, collectivism and the role of the family in SDM, challenges in the communication, etc. These issues may provide new insights to address the global development and implementation of SDM.

In Western countries (defined as dominance of Western ideology, such as the European Union and the Five Eyes Alliance, an intelligence-sharing partnership among Australia, Canada, New Zealand, the UK and the USA), SDM is often viewed as a collaborative process for clinicians and patients to work together to make healthcare decisions.1 The focus of SDM is generally to respect of the autonomy and right of the patient to participate in healthcare decisions.2 Western countries typically promote open communication and patient empowerment. Over the past two decades, there has been a rapid increase in research on SDM worldwide,3 but most publications originate from Western countries. The number of studies and investigators reflects the strength of collaboration across western institutions.3

However, the concept of SDM may take on different nuances in many Eastern countries due to cultural norms and societal values. In this context, ‘Eastern’ serves as a broad descriptor for various cultural and social structures, states and philosophical systems distinct from Western ideologies. It includes …