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Shared Decision Making and Evidence Based Medicine

Series Editor: Paula Riganti and Marleen Kunneman In shared decision making (SDM), patients and clinicians work together to make decisions about health and care. Together, they design care plans that fit for each patient, based on both the best available evidence, and the unique situation and priorities of each patient. Although there is an ethical imperative to involve patients in decisions about their own care, there is also growing evidence that patient involvement improves the quality of care, including patient satisfaction, patient decisional comfort and quality of life.  In the BMJ Evidence-Based Medicine series on SDM, we present original research, analysis, and opinion papers on the potential value of SDM to clinical care. This includes papers on the conceptualization of SDM, the occurrence of SDM in clinical practice and the effectiveness of interventions to improve SDM, core outcomes relevant to SDM and appropriate assessment of these outcomes, and effective (system-wide) implementation of SDM, including implementation in diverse patient populations and complex situations. Analysis: Metro Mapping: development of an innovative methodology to co-design care paths to support shared decision making in oncology Stiggelbout A, Griffioen I, Brands J, Melles M, Rietjens J, Kunneman M, van der Kolk M, van Eijck C, Snelders D. “We developed the service design methodology ‘Metro Mapping’ to improve SDM in oncology, using pancreatic cancer as an example. In this paper, we describe the development of this methodology and the first evidence on its implementation.” Opinion: The paradox of using SDM for de-implementation of low-value care in the clinical encounter. Riganti P, Kopitowski KS, McCaffery K, van Bodegom-Vos L. “Focusing on the conversations between patients, caregivers and clinicians during the clinical encounter, we reflect on why using SDM for de-implementation of low-value care can be paradoxical.” Research - Highlight ISDM2022 Conference: Problem-based shared decision-making in diabetes care: a secondary analysis of video-recorded encounters Ruissen MM, Montori VM, Hargraves IG, Branda ME, León García M, de Koning EJ, Kunneman M.  The objective of this study was to describe the range of collaborative approaches to shared decision-making (SDM) observed in clinical encounters of patients with diabetes and their clinicians through secondary analysis of videorecordings obtained in a randomised trial comparing usual diabetes primary care with or without using a within-encounter conversation SDM tool. Research - Highlight ISDM2022 Conference: Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed-methods pilot study. Humphries B, León-García M, Bates SM, Guyatt G, Eckman MH, D'Souza R, Shehata N, Jack SM, Alonso-Coello P, Xie F. Through a mixed methods explanatory sequential pilot study, the authors aimed to gain insight into formal methods of integrating patient preferences and clinical evidence to inform treatment decisions, we explored patients’ experience with a personalised decision analysis intervention, for prophylactic low-molecular-weight heparin in the antenatal period.  Analysis: The limits of shared decision making Elwyn G, Price A, Franco JVA, Gulbrandsen P. “However, there are also situations where taking a shared approach to decisions is not possible, although this does not rule out the need to provide empathetic care. There are limits to SDM, and the goal of this article is to be clear about the type of situations where SDM faces limits and where other strategies will need to be considered.” Linked Opinion: Caring without boundaries: delimiting shared decision-making Montori V, Kunneman M. “Although focused on its limits, Elwyn et al. state that SDM may be applied more widely than many clinicians think possible. We would add that perhaps SDM, as a method of care, may be applied even more widely than the field of SDM currently assumes.” Linked Correspondence on 'The limits of shared decision making' by Elwyn et al: We call for a more nuanced approach. Ijaz N, Wieland LS, Gallego-Pérez DF. “Like the article’s authors, we identify as ‘strong advocates of shared decision-making (SDM)’ while recognizing some limits to its application (Elwyn et al, p.1) However, we find the article’s interpretation of SDM principles to be lacking in nuance on multiple fronts.” Analysis Shared decision-making as a method of care. Montori VM, Ruissen MM, Hargraves IG, Brito JP, Kunneman M. Therefore, we believe SDM is not ‘another thing clinicians must do’, that is, to help patients select the best evidence-based option given their preferences, but that it is a method of care, as central to the clinician’s art as history taking, the physical examination, the selection and interpretation of diagnostic tests, and patient education and counselling.” Opinion and Debate: Can shared decision making address COVID-19 vaccine hesitancy? Durand MA, Scalia P, Elwyn G. “The development of trustworthy information is a first and essential step towards shared decision making. Evidence-based tools however are only part of the solution. They need to be used by skilled and empathetic health professionals, who have learnt how to respect the concerns of an increasingly anxious public. There is good evidence that the combination of trusted evidence sources in the hands of competent professionals provides the best chance of dealing with vaccine hesitancy.”