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070 Shared decision making: a definition for clinicians
  1. Glyn Elwyn1,
  2. Pal Gulbrandsen2,
  3. Hannah Leavitt1,
  4. Eman Abukmail3,
  5. Marla L Clayman4,
  6. Adrian Edwards5,
  7. Jeanette Finderup6,
  8. Alana Fisher7,
  9. Stuart W Grande8,
  10. Pola Hahlweg9,
  11. Tammy Hoffmann10,
  12. Wen-Hsuan Hou11,
  13. María José Hernández-Leal12,
  14. Debra Leung13,
  15. Weiwei Lu14,
  16. Lars Mandelkow15,
  17. Kristen E Pecanac16,
  18. Arwen H Pieterse17,
  19. Jannicke Rabben18,
  20. Paula Riganti19,
  21. Michael Sanatani20,
  22. Fülöp Scheibler21,
  23. Elise Schoefs22,
  24. Owen A Taylor23,
  25. Kathrene D Valentine24,
  26. Richard Wexler25
  1. 1Coproduction Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA
  2. 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia
  4. 4Center for Health Organization and Implementation Research (CHOIR), Veterans Health Administration, DC, USA
  5. 5Division of Population Medicine, Cardiff University, Cardiff, UK
  6. 6Department of Medicine and Nephrology, Aarhus University, Aarhus, Denmark
  7. 7CentreClinic, School of Psychological Sciences, Macquarie University, Sydney, Australia
  8. 8Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA
  9. 9Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  10. 10Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia
  11. 11Department of Physical Medicine and Rehabilitation, Taipei, Taiwan
  12. 12Department of Community, Maternity and Pediatric Nursing, University of Spain, Pamplona, Spain
  13. 13Department of Anaesthesia, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Victoria, Australia
  14. 14Department of Social and Behavioural Sciences, City University of Hong Kong, HKSAR, China
  15. 15Centre for Shared Decision Making, University Hospital of North Norway, Tromsø, Norway
  16. 16School of Nursing, University of Wisconsin-Madison, Madison, USA
  17. 17Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical, Leiden, Netherlands
  18. 18Faculty of Health and Sport Science, University of Agder, Oslo, Norway
  19. 19Family and Community Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires Argentina
  20. 20Division of Medical Oncology, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
  21. 21National Competency Center for Shared Decision Making, University Medical Center Schleswig-Holstein, Kiel, Germany
  22. 22Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
  23. 23Cardiovascular Epidemiology Unit, Cambridge Biomedical Campus, Cambridge UK
  24. 24Department of General Internal Medicine, Massachusetts General Hospital, Boston, USA
  25. 25Informed Medical Decisions Foundation, Boston, USA

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.

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