Practical differences between the forms of shared decision-making (SDM)
| What is the problem? | You and your patient are talking about… | The conversation or the decision is difficult because… | The patient may be feeling… | You and your patient can use this form of SDM to… |
| Matching preferences | ||||
| The problem is clearly defined and can often be established ahead of the conversation. Its solution is in one of the options presented. | The likely positive and negative effects of a specific illness and its treatment options. | It is uncertain what will happen, and hence which option is preferable. | Uncertain, fearful of what could happen, and worried about making a wrong choice. | Address uncertainty by matching the threat of what could happen to the benefits, harms, and burdens that the patient prefers to take. |
| Reconciling conflicts | ||||
| The problem involves an internal (two values or goals in tension) or external (disagreements with important others or with the clinician) conflict. | The stance on an issue (eg, disease, diagnosis, treatment, guidelines, relationships) taken by the patient, clinician or others. | There is conflict or tension within the patient or between the patient and other parties. | Disoriented, pulled in multiple directions, torn, guilty, ashamed, adamant, indecisive, not knowing who or what to trust, relationally hurt. | Reconcile conflicts within the patient or between parties so that an acceptable, honest, comfortable, self-aware, or committed position on next steps is found. |
| Problem-solving | ||||
| The problem is not clearly understood prior to the conversation. The problem comes into sharper focus as it is used to find reasons to proceed in one way or another. | A difficult situation | The situation is practically and emotionally troubling, due to multiple, often unclear, competing or limiting factors with limited capacity to rectify. | Stuck, incapacitated, diminished, trapped, threatened, hopeless. | Change the situation by problem-solving–uncovering the actionable factors contributing to the situation, generate ideas for changing them, and experimenting with them in the conversation. |
| Meaning making | ||||
| The problem involves an existential threat or transition. | A person’s or community’s meaning or identity and what ultimately matters in the situation. | Who the person and their community is in the face of life changes is in question or threatened. | Splintered, lost, no longer themselves, resigned, fearful, not at peace, deprived of what makes them whole and gives life meaning. | Work with the patient and their community to make meaning and find a way to feel at peace or whole again, secure in the knowledge of what ultimately matters in the situation |