When to Use Shared Decision Making: Clinical Situations

What is Shared Decision Making?

Shared decision making is a key component to a patient feeling empowered. It is a process that honors both the provider’s and the patient’s expertise: the provider’s expertise and clinical evidence of tests, treatments, and care plans that balance risks and benefits with the patient’s expert knowledge of what’s most important to them.

Why is it Important?

In many situations, there is no single “right” health care decision because choices about treatment, medical tests, and health issues come with pros and cons. Shared decision making helps providers and patients agree on a health care plan. Research shows that patients who actively participate in decision making are better informed and are more likely to follow through and adhere to treatment plans.

How to Determine When Shared Decision Making Should be Initiated:

Shared decision making (SDM) places importance on a patient’s values and preferences and is most appropriate when:

• There is more than one clinically reasonable option available to the patient.
• Each option is neither right nor wrong and has different risks and benefits.

SDM may not be appropriate in situations where there is clearly one medical treatment path. For example, the use of an antibiotic to treat a life-threatening infection.

Examples of Oncology Clinical Situations When SDM should be Considered:

• A change in treatment is needed because of recurrence, or a change in health status of the patient
• A clinical trial is an option versus receiving standard treatment
• A patient has incurable cancer and palliative care is an option
• An individual could consider a lumpectomy and radiation therapy versus a mastectomy for early-stage breast cancer
• There is the option of radical prostatectomy versus radiation therapy for early-stage prostate cancer
• Cancer screenings (e.g., a patient could consider a stool test, flexible sigmoidoscopy, colonoscopy, or CT colonography (virtual colonoscopy) for colon cancer screening)
• The individual seeking care loses their job and health insurance and is unsure of how they’re going to pay for their treatment