title: Shared decision making: a model for clinical practice.
abstract: The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting "what matters most" to patients as individuals, and that this exploration in turn depends on them developing informed preferences.
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Neuadd Meirionydd, Cardiff University, Heath Park, Cardiff, UK, CF14 4XN. glynelwyn@gmail.com
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Dominick
authors.initials: D
authors.lastname: Frosch
authors.forename: Richard
authors.initials: R
authors.lastname: Thomson
authors.forename: Natalie
authors.initials: N
authors.lastname: Joseph-Williams
authors.forename: Amy
authors.initials: A
authors.lastname: Lloyd
authors.forename: Paul
authors.initials: P
authors.lastname: Kinnersley
authors.forename: Emma
authors.initials: E
authors.lastname: Cording
authors.forename: Dave
authors.initials: D
authors.lastname: Tomson
authors.forename: Carole
authors.initials: C
authors.lastname: Dodd
authors.forename: Stephen
authors.initials: S
authors.lastname: Rollnick
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.forename: Michael
authors.initials: M
authors.lastname: Barry
mesh_terms: D003299:Cooperative Behavior; D003657:Decision Making; D006801:Humans; D008960:Models, Psychological; D010358:Patient Participation / Q000379:methods* / Q000523:psychology; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations