Shared Decision-Making

Shared decision-making means you and your healthcare providers work together to make choices about your care. It can help you as a patient, or as a loved one if you’re making decisions for them.

Unlike informed consent, shared decision-making is a two-way conversation where you play an active role. Your provider tells you about your treatment options and gives you recommendations. In turn, you tell them what you want from your care and what’s important to you along the way. Sharing information that way lets you and your provider decide on what’s best for you.

Shared decision-making is common in many healthcare settings, from primary care to specialties like eye or dental care. Some examples of ways it might happen include:

• Deciding whether you want your provider to screen you for certain diseases
• Choosing how to manage a chronic condition
• Selecting a surgery or treatment, or choosing options for a procedure, like the anesthesia type
• Picking a procedure that will have permanent effects, like preventing pregnancy or cancer

In an emergency, providers focus on stabilizing you first (unless you have an advanced directive like a DNR). Once you’re stable, shared decision-making can continue with you or a decision-maker you’ve chosen.

What if I don’t have a healthcare background?

You don’t need a medical background to take part in shared decision-making. Your providers bring the medical expertise, and you bring expertise about yourself (or the person you’re speaking for).

When making choices, you consider your wants, needs, values, opinions and past experiences. Your provider may ask questions to learn how those factors might affect or guide your care.

If something on the medical side isn’t clear, ask your provider to explain. That’s part of their job.

What if I’m comfortable letting my physician take the lead?

It’s common to trust your healthcare provider. Shared decision-making still builds on that trust, but some people prefer not to focus on their own role. If that’s true for you, let your provider know. They can adjust how they share information so you feel more comfortable.

What if I don’t feel listened to by my provider?

Shared decision-making means your provider listens and works with you to plan your care. Part of their role is offering options. They’ll start with treatments that are safest and most likely to work. You can ask about other options, too.

If you suggest an option your provider feels is unsafe or unlikely to help, they may decline for ethical reasons. Physicians take an oath to “first, do no harm.” Other healthcare professionals take similar oaths. They may also decline if they can’t safely provide the treatment (like if it’s outside their skill set), have concerns about the treatment or if it isn’t legal where you live.

If that happens, you can seek a second opinion. Another provider may offer what you want, or they may confirm it isn’t a safe or available option.

What might some examples of shared decision-making look like?

There are a few ways shared decision-making can happen. One way is for your provider to start the conversation.

Example: During your annual checkup, your provider notices your blood pressure is a bit high. Your provider tells you about it and says there are a few options. You can start taking a medicine or make some lifestyle changes, like adjusting what you eat or how active you are. Your provider recommends trying lifestyle changes first and using medicines as a second option.

You don’t like taking medicine, but you’re also unsure how to start with lifestyle changes. Your provider offers resources on adjusting what you eat and being more active. Then they schedule a follow-up visit in a few months to see if your numbers change.

Another way is for you to start the conversation.

Example: You tell your primary care provider think you have symptoms of carpal tunnel (which tests confirm you have). Your provider refers you to a specialist. You tell the specialist you want anything other than surgery. You explain you had an unpleasant experience with general anesthesia during a childhood surgery. You don’t want surgery because you’re afraid something like that will happen again.

The specialist tells you that surgery is the best option in your case. But they suggest using nerve blocks instead of general anesthesia. You’ll be awake but won’t feel pain during the surgery, because the blocks will numb your hand and wrist. You agree. The surgery takes mere minutes, goes as planned, and you’re awake and pain-free during it.