What is shared decision-making?

An explanation from KPWHRI researchers about discussing treatment options with a medical provider

Many times in health care, we're given several choices for tests or treatment. The scientific evidence for one test or treatment might make the choice easy. In other cases, deciding on the best choice can be difficult. Each option has downsides and upsides. There is no single choice that is right for everyone. 

In these situations, the decision is called "preference-sensitive" because the “best” decision is one that is based on a well-informed patient making a decision that is aligned with their own preferences. When you are facing a complex test or treatment decision, it is especially important to think about your preferences as the patient — your interests, priorities, and goals.

David Arterburn, MD, MPH, a Kaiser Permanente Washington Health Research Institute senior investigator and doctor with the Washington Permanente Medical Group, has studied how to help patients work with their medical team to make health care choices about preference-sensitive conditions. "For preference-sensitive situations," Dr. Arterburn says, "a process called shared decision-making can help you and your medical provider find out what type of care will probably be best for you."

Examples of preference-sensitive conditions that have several care options include:

• Knee or hip pain from a condition such as arthritis. Treatment choices can include braces or other supports, physical therapy, medications including injections, and surgery including knee or hip replacement.
• Screening for lung, colorectal, breast, or prostate cancer. Decisions about screening might depend on factors such as family history or tobacco use, and personal preferences about avoiding cancer or risking harm from screening such as radiation exposure. 
• Obesity or diabetes related to obesity. Treatment possibilities for these conditions might be a diet and exercise plan, medication, or bariatric (weight-loss) surgery. Each option has different potential benefits and risks.
• Neck or low back pain. Similar to knee or hip pain, treatment options might be light activity or physical therapy, over-the-counter pain medications, prescription medications such as muscle relaxants, or surgery.  
• Coronary artery disease. Treatment options might be taking medicine or getting surgery.

What is shared decision-making?

Shared decision-making is a conversation between you as a patient and your doctor or medical team. In the conversation, you and your medical provider will review information about all of your available test or treatment possibilities. That will often include information about the benefits and the risks of these different alternatives. You might be given a patient decision aid to review before or during the conversation.

Dr. Arterburn has developed and studied these aids that support shared decision-making. "A decision aid can be a video or written or online materials," he says. "A good decision aid should use words, numbers, and pictures that you can easily understand."

The information you're given should clearly describe your test or treatment options without encouraging you to choose one over the others. Instead, you should feel that you are being told about both risks and benefits of all options. Examples of possible risks include that a test or treatment might not work for you and might even cause harm, such as an allergic reaction to a medication or the need for more invasive tests or surgery. Examples of benefits are the likelihood that the test or treatment will help you achieve your goals. Goals might include being free from pain, not needing to take drugs, or greatly reducing risk of a disease such as diabetes, heart disease, or cancer.

What should you expect in shared decision-making?

The shared decision-making process will depend on the condition and the treatment choices. Your medical team's process or decision aids might be different from another team's. Shared decision-making should include:

• Encouraging you to ask questions and have an active role in making care decisions
• Reviewing the options in ways that you understand
• Discussing both risks and benefits of care options
• Asking what you want from the test or treatment
• Giving you time to think and ask questions
• Describing what happens after you and your medical team make a decision
• Helping you follow up on the decision

"Clinical research shows that shared decision-making helps people understand their care options and what to expect from the different options,” said Jane Anau, a research project manager who works closely with Dr. Arterburn on obesity and shared decision-making about treatments including bariatric surgery. “It helps people feel less uncertain about their health care decision because they've made a choice that fits their values."

If you're interested in shared decision-making, here's more information that uses diabetes as an example.​​​​​​