Table 2.

Key questions and linked learning objectives for the SDM subtheme of doctor-patient communication

KEY QUESTIONS TO ENGAGE LEARNERS	LEARNING OBJECTIVES	KEY POINTS FROM THE ARTICLE SERIES
Many screening recommendations from the Canadian Task Force on Preventive Health Care can be qualified as conditional Question 1: Conditional on what?	1a. Explain what is meant by the concept of a conditional recommendation for a screening intervention 1b. Distinguish between conditional and strong recommendations in terms of when to engage in SDM	SDM should be considered when there are at least 2 medically valid options yielding a balance between benefits and harms (equipoise) If the recommendation is conditional and in favour of the intervention: offer a discussion about it If the recommendation is conditional and against the intervention: engage in SDM only when a patient asks about it
SDM is a structured process used to improve decision making Question 2: What are the core elements of SDM?	2a. Describe the core elements of SDM 2b. Demonstrate the ability to engage in SDM with a patient	The core elements of SDM are risk communication and values clarification To get at these elements, use infographics and decision aids
Patient preferences for treatment of conditions detectable through screening are highly variable Question 3: How would you explain the following concepts: patient values and patient preferences?	3a. Describe what is meant by patient values and preferences using examples 3b. Demonstrate how to elicit patient values and preferences	Values clarification considers both patient values and patient preferences Values refer to how patients value the clinical outcomes arising from the various options Values help determine preferences Preferences are inclinations toward or away from an option
Some patients do not understand the meaning of values in the context of decision making about screening interventions Question 4: With respect to a screening decision, how would you help a patient clarify their values?	4a. Explain the relationship between values and the health outcomes of screening interventions using examples 4b. Demonstrate the ability to facilitate a patient decision	In the context of SDM, values pertain to the importance patients place on the potential beneficial and harmful outcomes that can result from a screening intervention or test. Patients’ preferences are the health care options they most favour For screening decisions, clarifying values focuses on determining patients’ desires to diagnose disease early as well as their understanding and aversion to the risks and implications of false-positive test results and overdiagnosis Clarifying patients’ values often helps inform their preferred options, but it can also be challenging for patients who prefer not to be involved in decision making
Tools can facilitate the process of SDM Question 5: How can infographics or decision aids be incorporated into the office visit?	5a. Explain the difference between an infographic and a decision aid 5b. Demonstrate an ability to use tools at the point of care to improve decision making	Many screening recommendations highlight the close balance between benefits and harms
SDM is not appropriate for all situations Question 6: When is SDM probably not the right approach?	6a. Using an example, explain when SDM should be introduced and when it should not be introduced 6b. Explain the difference between sharing information and SDM	In strong recommendations, the balance between benefit and harm is not close to even While SDM is often underused, it may be introduced in situations where it probably should not be used When SDM is not warranted, sharing information remains a good practice

SDM—shared decision making.