Shared Decision-Making

#A conversation with different kinds of knowledge

Shared decision-making is a process in which a person and their healthcare professional discuss reasonable care options together. The professional contributes knowledge about the condition, evidence and clinical risks. The person contributes knowledge about their life, experiences, concerns and the outcomes that matter most to them.

This does not mean every option is equally safe or effective. Healthcare professionals still explain which choices are medically appropriate and why. Where several reasonable options exist, personal priorities can help determine how their benefits, harms and practical demands are weighed in the discussion.

#Evidence informs choices without removing uncertainty

Research describes what happened in groups of people, but it cannot perfectly predict an individual's result. Discussions may include how likely benefits and harms are, how reliable the evidence is and whether study participants resemble the person considering treatment. Missing information should be made clear.

Personal priorities might include symptom relief, independence, fertility, time away from work or avoiding particular side effects. Cost, travel and caring responsibilities can also affect what is workable. Decision aids can help organise this information, but they support rather than replace a conversation about the available choices.

#Participation can take different forms

People differ in how much responsibility they want during decisions. Some prefer a detailed comparison; others want a professional recommendation after explaining their priorities. With permission, family members, carers or trusted supporters may participate. Clear language, interpretation and accessible information can make meaningful involvement easier.

Decisions may need more than one conversation, although urgent situations can limit discussion time. Shared decision-making also includes checking understanding and recording what was agreed. A choice can be revisited if health, evidence or preferences change; agreement at one point does not make every future decision automatic.

#Common misunderstandings

Shared decision-making does not mean that every option is equally suitable, or that a clinician must offer treatments unlikely to help. Clinical expertise still matters: clinicians explain which options are reasonable, discuss benefits and harms, and can recommend an approach while explaining their reasoning.

It also does not mean leaving someone to decide alone. Information without discussion can feel like a transfer of responsibility rather than a partnership. Support may include clearer explanations, an interpreter, accessible materials or time to involve a trusted person.

Nor does a shared decision require complete agreement or certainty. People and clinicians may initially view the choices differently. Exploring those differences can reveal concerns, practical barriers or misunderstandings that affect the decision.

Finally, a decision is not always permanent. Where clinically appropriate, it can be reviewed as circumstances, preferences or evidence change. Agreeing when to revisit a choice can be part of the original conversation.

#Questions worth asking a clinician

• What are my treatment options, including waiting or doing nothing, and what benefits and harms could each bring?
• How strong is the evidence for each option, and how well does it apply to my situation?
• How could each option affect my daily life, including work, caring responsibilities and costs?
• How can we use my goals, values and concerns to choose the best option for me?
• Can we agree on how involved I want to be and whether to include someone I trust in our discussions?