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Patients as partners in care are at the heart of shared decision making (SDM), a model where clinicians and patients deliberately work together to choose tests and treatments that fit both best evidence and the patient’s values and life context.

What shared decision making means

• SDM is a collaborative process in which clinicians contribute clinical expertise while patients contribute their goals, preferences, and lived experience.

• Core elements include at least two participants (patient and clinician), information sharing in both directions, building a shared understanding of options, and aiming for agreement on what to do next.

From paternalism to partnership

• Historically, medical care was strongly paternalistic, with clinicians deciding and patients expected to comply, but from the 1970s onward, growing emphasis on autonomy and patient‑centered care began to challenge this model.

• The term “shared decision-making” appeared in ethical discussions in the 1970s and early 1980s and gained momentum in the 1980s alongside evidence that patients increasingly wanted to participate in decisions.

Why patients as partners matters

• SDM is associated with improved patient knowledge, more accurate risk perception, reduced decisional conflict, and treatment plans that better reflect what matters most to patients.

• Studies link SDM to higher satisfaction, better adherence, improved quality of life, lower anxiety, and in some preference‑sensitive conditions, less invasive and sometimes less costly care.

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What makes SDM possible today

• Drivers of SDM’s “rise” include policy pushes toward patient‑centered care, wider access to health information online, more complex treatment options, and recognition of unwarranted practice variation that ignores patient preferences.

• Decision aids, digital tools, and interprofessional team models now support SDM at the point of care by structuring options, clarifying trade‑offs, and giving patients time and language to express what they value.

Barriers and practical steps

• Common barriers are time pressure, clinician discomfort with uncertainty, limited training in SDM communication, low health literacy, and organizational cultures still oriented to “doctor knows best.”

• Practical enablers include brief question prompts (“What matters most to you about this decision?”), use of concise decision aids, normalizing patient participation, and integrating SDM into workflows and quality metrics.