Shared decision making: what do clinicians need to know and why should they bother?

In reply: We thank Picone and Levinson for their comments on our article. Levinson raises concerns about situations involving clinical decisions in which evidence is lacking (eg, for patients with complex multiple morbidities), urgent and emotional consultations, and management of patients with cognitive impairment. Certainly, such situations make clinical care encounters more difficult. We acknowledge that shared decision making may not always be possible, and that sometimes the process may need to extend to family or a health care proxy. Nor will it always be desired by every patient or for every health care decision. Nevertheless, it should at least be offered. When there are multiple morbidities, with each needing a decision, one approach is to address each in turn, dealing with interactions between them, as we do for other clinical modalities.

Decisions are not helped by being rushed. The use of decision support tools is not limited to within-consultation use — many can also be used before and after consultations, which can enable loved ones to be better involved. Research into less-traditional models of shared decision making and exploration of how it can involve teams of health professionals, family caregivers and older patients has begun to emerge,1 and this will help to inform future practice.

We disagree that shared decision making might result in “doctors abdicating responsibility for making difficult decisions”. This is one of the misperceptions that we address in our article. The shared decision-making process involves ensuring that the best information — and the consequences of each option — is clearly laid out for everyone involved (including the clinician).