Article Figures & Data
Figures
- Figure 1.
Three-step model of shared decision making
Data from Elwyn et al.5
- Figure 2.
Determining if SDM is the right approach: Tables 1 and 2 offer examples.
SDM—shared decision making.
- Figure 3.
Approach for when patients’ requests seem unreasonable
Inspired by a tool in progress from the Canadian Task Force on Preventive Health Care. Used with permission.
Tables
CARE OPTIONS* CATEGORIES EXAMPLES There are at least 2 medically valid options with a balance between benefits and harms If the recommendation is in favour of action, SDM should precede ordering the test or treatment
Mammography in women 50–74 y10
Screening for abdominal aortic aneurysm in men 65–80 y11
Statins for primary prevention of CVD in people at moderate risk
Many weak or conditional recommendations12 If the recommendation is against action, SDM is useful when the patient wants to know more about the option
PSA screening in men 55–70 y13
Mammography in women in their 40s10
In specific circumstances even if the balance between benefit and harms is usually not in equipoise The balance between benefits and risks is different for a particular patient
A potentially lifesaving surgery in a patient with multiple comorbidities in whom potential harms are important
Some strong recommendations in favour of action12 A patient who expresses the desire to discuss a specific recommendation
Colon cancer screening in adults 60–74 y14
CVD—cardiovascular disease, PSA—prostate-specific antigen, SDM—shared decision making.
↵* When there is a decision to be made and the patient can collaborate.
SITUATION* EXAMPLES There is no decision to be made There is no valid indication for a diagnostic or therapeutic maneuver (eg, you should not offer imaging in patients with acute low back pain and no red flags)
There is a clear urgency to act in a patient for whom benefits clearly outweigh possible harms (eg, unstablechest pain with elevated cardiac enzymes in a 50-year-old man in otherwise good health)
There is only one therapeutic option and the option of doing nothing would be detrimental (eg, reduction and immobilization of a fracture)
The patient has already clearly expressed he or she does not want an intervention
The patient cannot collaborate in the process Unable to participate in the decision† (eg, dementia)
Emotional overload (eg, at the time we announce a life-changing diagnosis)
Under the effect of substances that can alter judgment
Emotional crisis (eg, suicidal)
The balance between benefits and harms is not in equipoise Most strong recommendations in favour12 (eg, screening for hypertension in middle-aged people15)
Strong recommendation against12(eg, screening for dementia16; screening for thyroid dysfunction in nonpregnant adults17)
Some weak or conditional recommendations in favour12(eg, screening for tobacco smoking in children and adolescents18)
In this issue
Jump to section
Related Articles
Cited By...
- Reclaiming time in family medicine: Unnecessary clinical tasks as a hidden driver of workload burden
- Recuperer du temps en medecine familiale: Les taches cliniques inutiles comme declencheurs caches de la surcharge de travail
- The paradox of using SDM for de-implementation of low-value care in the clinical encounter
- Réduire les dosages systématiques inutiles de la vitamine D
- Reduce unnecessary routine vitamin D testing
- The limits of shared decision making
- Dépistage en prévention primaire des fractures de fragilisation: Combien de temps faut-il?
- Screening for primary prevention of fragility fractures: How much time does it take?
- The paradox of using SDM for de-implementation of low-value care in the clinical encounter
- Patient decision aid for flozins in heart failure and ejection fraction greater than 40%
- Aide à la décision dutiliser ou non les gliflozines pour linsuffisance cardiaque avec fraction déjection supérieure à 40 %, à lintention des patients
- Que devraient enseigner les educateurs pour ameliorer les soins de sante preventifs?
- What should educators teach to improve preventive health care?
- À lencontre du statu quo en matière de dépistage: Appel à laction pour améliorer lenseignement des soins de santé préventifs
- Going against the status quo in screening: Call to action to improve teaching in preventive health care
- Equipoise is preference sensitive