title: Shared decision making: Concepts, evidence, and practice.
abstract: OBJECTIVE
  Shared decision-making (SDM) is advocated as the model for decision-making in preference-sensitive decisions. In this paper we sketch the history of the concept of SDM, evidence on the occurrence of the steps in daily practice, and provide a clinical audience with communication strategies to support the steps involved. Finally, we discuss ways to improve the implementation of SDM.
  
  
  RESULTS
  The plea for SDM originated almost simultaneously in medical ethics and health services research. Four steps can be distinguished: (1) the professional informs the patient that a decision is to be made and that the patient's opinion is important; (2) the professional explains the options and their pros and cons; (3) the professional and the patient discuss the patient's preferences and the professional supports the patient in deliberation; (4) the professional and patient discuss the patient's wish to make the decision, they make or defer the decision, and discuss follow-up. In practice these steps are seen to occur to a limited extent.
  
  
  CONCLUSIONS
  Knowledge and awareness among both professionals and patients as well as tools and skills training are needed for SDM to become widely implemented.
  
  
  CONCLUSIONS
  Professionals may use the steps and accompanying communication strategies to implement SDM.
authors.affiliation: Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.m.stiggelbout@lumc.nl.
authors.forename: A M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: Pieterse
authors.affiliation: Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J C J M
authors.initials: JC
authors.lastname: De Haes
mesh_terms: D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D003695:Delivery of Health Care; D006302:Health Services Research; D006801:Humans; D010358:Patient Participation; D057240:Patient Preference; D010817:Physician-Patient Relations
keywords: Deliberation; Medical ethics; Patient preferences; Physician-patient communication; Shared decision making