Table 2

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.
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 situationThe 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