For which decisions is Shared Decision Making considered appropriate? - A systematic review.

Area of Science:

• Health Services Research
• Medical Decision Making

Background:

• Shared decision-making (SDM) is increasingly recognized as a crucial component of patient-centered care.
• Understanding the specific characteristics of clinical decisions where SDM is deemed appropriate or inappropriate is essential for effective implementation.

Approach:

• A comprehensive literature search was conducted using two strategies, including an updated review of existing SDM models and a new search across eight databases.
• The review analyzed 92 papers, encompassing original research, opinion pieces, and reviews, to identify decision characteristics and author viewpoints on SDM appropriateness.

Key Points:

• Authors identified 18 decision characteristics favoring SDM, such as preference-sensitive decisions, those with equipoise, and situations requiring patient commitment for implementation.
• SDM authors noted limitations, particularly in scenarios demanding immediate life-saving interventions.
• Disagreement among authors was observed for four decision characteristics regarding SDM's suitability.

Conclusions:

• The study highlights the wide range of decision contexts where SDM is considered appropriate, alongside areas of ambiguity and potential limitations.
• Findings suggest SDM is broadly applicable but requires careful consideration of decision complexity and urgency.
• The review provides valuable insights for refining SDM practices and educational initiatives.