title: Shared decision making: what do clinicians need to know and why should they bother?
abstract: Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments. The benefits of shared decision making include enabling evidence and patients' preferences to be incorporated into a consultation; improving patient knowledge, risk perception accuracy and patient-clinician communication; and reducing decisional conflict, feeling uninformed and inappropriate use of tests and treatments. Various approaches can be used to guide clinicians through the process. We elaborate on five simple questions that can be used: What will happen if the patient waits and watches? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice? Although shared decision making can occur without tools, various types of decision support tools now exist to facilitate it. Misconceptions about shared decision making are hampering its implementation. We address the barriers, as perceived by clinicians. Despite numerous international initiatives to advance shared decision making, very little has occurred in Australia. Consequently, we are lagging behind many other countries and should act urgently.
authors.affiliation: Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia. thoffmann@bond.edu.au.
authors.forename: Tammy C
authors.initials: TC
authors.lastname: Hoffmann
authors.affiliation: Centre Hospitalier Universitaire de Québec, Quebec, Canada.
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.affiliation: Orygen Youth Health Research Centre, Melbourne, VIC, Australia.
authors.forename: Magenta B
authors.initials: MB
authors.lastname: Simmons
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: McNamara
authors.affiliation: School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
authors.affiliation: School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Lyndal J
authors.initials: LJ
authors.lastname: Trevena
authors.affiliation: Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand.
authors.forename: Ben
authors.initials: B
authors.lastname: Hudson
authors.affiliation: Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Glasziou
authors.affiliation: Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Del Mar
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D002675:Child, Preschool; D003657:Decision Making; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D010033:Otitis Media / Q000188:drug therapy; D010358:Patient Participation; D017060:Patient Satisfaction; D010819:Physician's Role; D010817:Physician-Patient Relations; D011368:Professional-Family Relations
chemical_list: D000900:Anti-Bacterial Agents