Requirements for shared decision-making (SDM)

There are five requirements for successful shared decision making (SDM) between patients and their clinicians.

1. Knowing the pertinent science. This used to be the clinician’s job, but as the volume of information explodes and is democratized by the internet, it will increasingly be a shared task and dependent on technology. (Expecting a clinician to know all the pertinent facts is like expecting a travel agent to memorize all the plane schedules.)
2. Knowing the available options, along with their potential benefits and harms. This, too, will gradually become a shared task, though interpretation and explanation (providing context and clinical perspective) will remain largely the clinician’s responsibility.
3. Identifying the patient’s values and preferences. The clinician needs to be interested and the patient needs to be willing to disclose.
4. Willingness to share power. Parallel to the clinician’s willingness to relinquish control is the patient’s willingness to accept responsibility.
5. Time. The process of sharing information, and then asking and answering questions about the science, the options, and the patient preferences takes time and cannot be rushed.