##  [Shared Decision-Making](/shared-decision-making-1) 

 Definition

A structured, bidirectional clinical process in which a health professional and a patient (and when appropriate, caregivers) exchange information about diagnoses, treatment or management options, likely benefits and risks, and the patient's values and preferences, then deliberate together to arrive at an agreed healthcare decision or plan of care.

 

 

 

 

 

 





## Principle

Principle

When clinicians provide evidence about options and elicit and integrate a patient's informed values, the chosen intervention is more likely to reflect the patient's preferences and to be practically implementable for that patient.

 

 

 

 

 





## Demonstration

Demonstration

Illustrative scenario: Situation — An older adult and clinician face two treatment options with different trade‑offs. Recognition — Clinician explains outcomes, uncertainties and trade‑offs; clinician elicits the patient's priorities (e.g., mobility vs. longevity). Action — They review how each option maps to those priorities and choose the option aligning with stated values. Consequence — The resulting plan is explicitly documented and supported by a follow‑up plan that the patient understands.

 

 

 

 

## Misapplication

Misapplication

Treating SDM as merely providing information or obtaining a signature (i.e., delivering facts without eliciting or integrating patient preferences); the semantic error is omission of deliberation and preference integration, which are essential to SDM.

 

 

 

 

 





## Consequence

Consequence

Properly executed SDM changes the decision from clinician‑centred selection to a jointly negotiated plan; this can affect adherence, satisfaction, and allocation of resources but does not guarantee any specific clinical outcome.

 

 

 

 

## Reversal

Reversal

SDM is not practicable when a patient lacks decision‑making capacity and no valid surrogate exists, or when immediate life‑saving interventions are required and delay would increase harm; in those cases surrogate decision‑making or clinician‑directed emergency care applies.

 

 

 

 

 





## Boundary

Boundary

Clearly within: a scheduled treatment discussion where risks, benefits and patient values are explicitly exchanged and a decision is documented. Boundary case: a brief urgent consultation where some preference elicitation occurs but time limits prevent full deliberation. Clearly outside: unilateral clinician orders or routine informational handouts without patient engagement.

 

 

 

 

 





## Semantic Tension

Semantic Tension

Autonomy versus clinical expertise and efficiency: honoring individual preferences may conflict with evidence‑based standardization or time constraints in busy settings.

 

 

 

 

 





## Synthesis

Synthesis

SDM is a decision process, not a communication form: its distinguishing feature is two‑way exchange plus explicit elicitation and incorporation of the patient's values into the final plan.