title: Re-thinking shared decision-making: context matters.
abstract: OBJECTIVE
  Traditional perspectives on shared decision-making (SDM) focus attention on the point in a clinical encounter where discussion of a treatment decision begins. We argue that SDM is shaped not only by initiation of a treatment decision, but also by the entire clinical encounter, and, even more broadly, by the nature of the patient-provider relationship.
  
  
  METHODS
  The four habits approach to effective clinical communication, a validated and widely used framework for patient-provider communication, was used to understand how SDM is integrally tied to the entire clinical encounter, as well as to the broader patient-provider relationship.
  
  
  RESULTS
  The Four Habits consists of four categories of behaviors: (1) invest in the beginning; (2) elicit the patient's perspective; (3) demonstrate empathy; and (4) invest in the end. We argue that the behaviors included in all four of these categories work together to create and maintain an environment conducive to SDM.
  
  
  CONCLUSIONS
  SDM cannot be understood in isolation, and future SDM research should reflect the influence that the broader communicative and relational contexts have on decisions.
  
  
  CONCLUSIONS
  SDM training might be more effective if training focused on the broader context of communication and relationships, such as those specified by the Four Habits framework.
authors: Department of Veterans Affairs Health Services Research and Development Center on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, USA. mmatthia@iupui.edu
authors: Marianne S
authors: MS
authors: Matthias
authors: Michelle P
authors: MP
authors: Salyers
authors: Richard M
authors: RM
authors: Frankel
mesh_terms: D003142:Communication; D003657:Decision Making; D006801:Humans; D008962:Models, Theoretical; D011369:Professional-Patient Relations