Table 1

Forms of shared decision-making (SDM)

SDM form method descriptionSituations in which this form will be preferred
Matching preferences
Patients and clinicians compare features (ie, efficacy, burdens, side effects) of the available options and match them with the patient’s values, preferences, goals, and priorities. They may use an SDM tool to share information about the options. Patient and clinician deliberate until the best match is identified.Deciding whether participating in a screening programme is a desirable way to address the threat of breast cancer.
Selecting which of the available diabetes medications to use to achieve glycaemic control.
Reconciling conflicts
Using a collaborative process, the clinician helps the patient articulate the reasons for their position while reconciling those reasons with the varying possibilities ahead.Opting to take an antidepressant or not for mild depression in a patient who, up to now, thinks that psychoactive medications must be avoided.
Determining whether to curtail driving privileges in an elderly patient with potentially dangerous levels of visual and cognitive impairments.
Problem-solving
Potential solutions are tested—in conversation or therapeutic trials—and become justified based on the extent to which these can demonstrably and successfully address the problem and improve the patient’s situation.Determining how far to reduce blood pressure in a patient with hypertension and frailty with a tendency to fall and a history of taking medications erratically.
Deciding when to discharge a patient home from the hospital, figuring out what accommodations and ongoing support and care will be needed and who will ensure the patient receives it.
Meaning making
Using conversations, patient and clinician develop insight into what the patient’s situation means, at a deep level, to the patient and their community and to find the reasons within that process for pursuing a particular approach.Deciding how the dying patient will transition off life-support technologies in preparation for death.
Planning the extent, type and timing of gender affirming therapies in individuals transitioning to a different gender.