An integrative model of shared decision making in medical encounters.
OBJECTIVE
Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions.


METHODS
In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December 2003 with the words shared decision making in the title or abstract. The search yielded 681 citations, 342 of which were about SDM in the context of physician-patient encounters and published in English. We read and reviewed the full text of all 342 articles, and got any non-redundant references to SDM, which yielded an additional 76 articles.


RESULTS
Of the 418 articles examined, 161 (38.5%) had a conceptual definition of SDM. We identified 31 separate concepts used to explicate SDM, but only "patient values/preferences" (67.1%) and "options" (50.9%) appeared in more than half the 161 definitions. Relatively few articles explicitly recognized and integrated previous work.


CONCLUSIONS
Our review reveals that there is no shared definition of SDM. We propose a definition that integrates the extant literature base and outlines essential elements that must be present for patients and providers to engage in the process of SDM.


CONCLUSIONS
The integrative definition of SDM is intended to provide a useful foundation for describing and operationalizing SDM in further research.
Makoul
Gregory
G
Program in Communication and Medicine, Division of General Internal Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 200, Chicago, IL 60611, USA. makoul@northwestern.edu
Clayman
Marla L
ML
D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D006801:Humans; D007258:Informed Consent; D008960:Models, Psychological; D017008:Negotiating; D017063:Outcome Assessment, Health Care; D026706:Paternalism; D010353:Patient Education as Topic; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D018802:Patient-Centered Care; D010819:Physician's Role; D010817:Physician-Patient Relations; D011340:Problem Solving; D018570:Risk Assessment; D020377:Self Efficacy; D012803:Sick Role; D035502:Trust