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Patient shared decision making (SDM)

Evidence Rating

Scientifically Supported

Health Factors

Decision Makers

Under a shared decision making (SDM) process, health care practitioners and patients work together to make joint decisions about a patient’s care. SDM requires that patients be educated about and understand risks and benefits of their options (). SDM is an important part of patient-centered care; education is often through the use of decision aids such as pamphlets, videos, and computerized tools.

Expected Beneficial Outcomes

  • Improved patient knowledge

  • Improved patient decision making

  • Increased use of cost-saving procedures

  • Reduced use of expensive procedures

Evidence of Effectiveness

There is strong evidence that patient shared decision making (SDM) using decision aids improves patients’ knowledge of treatment options and increases their involvement in the decision making process (, ). Patient SDM using decision aids may also improve health outcomes ().

Decision aids increase patients’ knowledge about their treatment options (, ) and can reduce anxiety related to treatment (, , ). Using probabilities in those aids, especially expressed in numbers, improves the accuracy of the level of risk patients perceive (). Computerized aids appear as effective as aids delivered in person ().

Decision aids improve patient participation in their treatment decisions () and help patients make difficult decisions (, ). SDM has been shown to be particularly effective for patients making long-term decisions and patients with chronic health problems (). Use of decision aids has been shown to reduce the frequency of major elective surgeries, PSA screening, and the choice to use menopausal hormones (). SDM can also support women’s decision making related to pregnancy and birth (). Educational meetings, feedback, learning materials, and decision aids may help health care providers adopt SDM ().

The impact of patient shared decision making on health care costs is unclear. Some studies show no savings, though no additional costs, while others suggest per person savings ranging from $8 to $3,068 ().

Impact on Disparities

No impact on disparities likely

Implementation Examples

The Informed Medical Decisions Foundation supports 10 shared decision making demonstration sites across the country. It also has developed a variety of decision aid programs, focusing on topics such as breast cancer, cardiovascular disease, screening and testing programs, and mental health (IMDF).

Implementation Resources

IMDF-Resources - Informed Medical Decisions Foundation (IMDF). Shared decision making resources.

Citations - Evidence

* Journal subscription may be required for access.

Cochrane-Legare 2010* - Légaré F, Ratté S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database of Systematic Reviews. 2010;(5):CD006732.

Cochrane-Stacey 2014* - Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. 2014;(1):CD001431.

Joosten 2008* - Joosten EAG, DeFuentes-Merillas L, de Weert GH, et al. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics. 2008;77(4):219–26.

OBrien 2009* - O’Brien MA, Whelan TJ, Villasis-Keever M, et al. Are cancer-related decision aids effective? A systematic review and meta-analysis. Journal of Clinical Oncology. 2009;27(6):974–85.

Dugas 2012* - Dugas M, Shorten A, Dubé E, et al. Decision aid tools to support women’s decision making in pregnancy and birth: A systematic review and meta-analysis. Social Science & Medicine. 2012;74(12):1968–78.

Sheehan 2012* - Sheehan J, Sherman KA. Computerised decision aids: A systematic review of their effectiveness in facilitating high-quality decision-making in various health-related contexts. Patient Education and Counseling. 2012;88(1):69–86.

Walsh 2014* - Walsh T, Barr PJ, Thompson R, et al. Undetermined impact of patient decision support interventions on healthcare costs and savings: Systematic review. BMJ. 2014;348:g188.

Citations - Implementation Examples

* Journal subscription may be required for access.

IMDF - Informed Medical Decisions Foundation (IMDF). Advancing shared decision making.

Date Last Updated

Sep 4, 2014
  • Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
  • Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
  • Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
  • Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
  • Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
  • Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.