• What is shared decision making?
• Why is shared decision making important?
• What is a "good" health care decision?
• Bibliography on shared decision making and decision aids

Two definitions of shared decision making:

1. The process of interaction with patients who wish to be involved with their health care providers in making health care decisions
2. Involvement of patients with their providers in making health care decisions that are informed by the best available evidence about treatment / screening / illness management options, potential benefits, and harms, and that consider patient preferences.

Shared decision making combines the measurement of patient preferences with evidence-based practice.

Shared decision making includes the aspect of interaction and communication in the process of making a decision.

• Many clinical decisions involve value judgments
• Interventions have different benefits/ risks that patients value differently
• There is no single right answer for everyone
• Ethical principle of patient autonomy and legal requirement of informed consent
• Health care providers cannot automatically infer what patients value, nor can they assume what care decisions are in patients' best interest.
• Evidence-based practice movement
• Increasing realization that an important piece of evidence is missing without the patient’s perspective
• Uncertain nature of clinical information

• Informed
• Supported by best available evidence
• Compatible with patient’s values
• Practical
• Considers patient preferences
• Weighs pros and cons

• Achieves optimum improvement in health and piece of mind in the patient (Angell, 1999)
• Well informed, supported by the best available evidence, weighs pros and cons, compatible with patient's values and practical (Dow, 1999).
• Adequate information, satisfaction with the decision making process, and satisfaction with the outcome (Kuperman and Nease, 1999).

• At least 2 participants are involved - health care provider and patient
• Information is shared
• Participants take steps to build consensus about the preferred treatment / care
• Agreement is reached on the decision to be implemented

Patient Experiences Values and Preferences		SDM INTERACTION		Clinician Treatment Options Potential benefits, harms, outcomes
Family, Society

• Relationships and roles are unclear
• Objective data are inadequate
• Values, interests and assumptions are unexplored
• Too few options have been considered
• Alternatives are unclear
• Communication is poor
• The decision is difficult to justify (Fisher & Fisher, 1999)