Collaborative Decision Making

Decisions about tests, medications, procedures, referrals, or health behaviors are an integral component of many medical encounters, and collaborative decision making, also known as shared decision making (SDM), is frequently advocated in teaching, research, and policy regarding patient-centered interaction as a way to improve everyday clinical practice. At root, SDM is a process through which providers and patients work together to make decisions. It is most relevant in preference-sensitive decisions, in which there are legitimate treatment options that different people may view in different ways.

The term shared decision making was first defined by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its report “Making Health Care Decisions,” which focused on informed consent. This report was published in 1982, and cast SDM as a process based on mutual respect and partnership. Hundreds of articles have been published since, and there is a plethora of workshops and other training programs on SDM. In more recent literature, SDM is referred to as “collaborative decision making,” but the two terms are synonymous for the process.

In terms of the provider–patient relationship, SDM is often positioned as a “middle ground” between paternalism (i.e., physicians make the decisions) and informed choice (i.e., patients make the decisions). In that context, there is considerable overlap between SDM and constructs with similar connotations, such as collaborative decision making, concordance, evidence-based patient choice, enhanced autonomy, informed [Page 198]choice, informed decision making, and mutual participation.

Models of SDM vary in the way they position the roles and responsibilities of providers and patients. Some suggest competencies for both parties, whereas others have placed more responsibility on the provider to elicit or respond to patients' views. The extent to which this happens in practice often depends upon the provider, the patient, and the situation (e.g., choosing a hypertension medication is very different from deciding whether to have a lumpectomy or mastectomy).