REVIEW – February 2023

Shared decision making in healthcare

Authors: Ireen Bruus, Talvi Annus

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Shared decision-making is a process in which the health professional and the patient reach the best health related decision based on evidence-based information and patient values. During the shared decisionmaking process, the health care professional shares evidence-based information about the condition, disease, possible options of health interventions and their benefits and harms. In turn the patient needs to share information about her/his values, preferences and beliefs. The use of the shared decision-making method improves patient knowledge, increases satisfaction with the consultation and with the health professional, as well as helps to improve good patient-healthcare professional relationship. In addition, shared decision making method increases patient’s self-confidence in deciding about his/her health.

There are multiple facilitators and barriers to the use of shared decision-making. The barriers include negative attitude of health professionals towards shared decisionmaking, presumption of patient wishes, insufficient communication skills of health professionals and lack of skills to implement shared decision-making. Moreover, patient’s mental and physical disability, poor prognosis, fear of contributing, low education, unrealistic expectations of treatment, previous negative experience in healthcare and occurrence of multiple chronic diseases are also barriers to implementing the shared decision making method. Also, additional bonuses for productive work, high turnover of patients, speedy discharge, inclusion of relatives, language barrier, noisy environment, lack of privacy, and involvement of multiple health professionals complicate the process. The facilitators for shared decision making are good patient-healthcare professional relationship, positive past experience in health care, use of decision aids, positive attitude of patients, willingness of the health professional to use the shared decisionmaking method and to educate patients, as well as the attempt of the organisation to move towards implementation of shared decision-making, good communication, and involvement of patients’ relatives.

Shared-decision making is implemented mainly in psychiatry, general practice, oncology, palliative care, and surgery. In these specialties shared decision-making leads to positive health related effects.