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It is time to recognise shared decision-making as a complex intervention.

Joanne E Butterworth1, Karen Mattick1, Suzanne H Richards2

  • 1Department of Health and Community Sciences, University of Exeter, Exeter, UK.

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|December 11, 2025
PubMed
Summary
This summary is machine-generated.

Shared decision-making (SDM) is best understood as a complex intervention, not a simple interaction. Recognizing SDM

Keywords:
Complex interventionMultiple long-term conditionsProgramme theoryShared decision-makingSocioecological model

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Area of Science:

  • Health Services Research
  • Implementation Science
  • Patient-Centered Care

Background:

  • Established shared decision-making (SDM) models are insufficient for diverse patient needs and wider health influences.
  • Current models obscure the pathway from SDM to positive health and healthcare outcomes.
  • Personalized healthcare requires a more nuanced understanding of SDM.

Purpose of the Study:

  • To re-conceptualize shared decision-making (SDM) as a complex intervention.
  • To advocate for a broader understanding of SDM beyond the patient-practitioner interaction.
  • To highlight the need for context-specific tailoring and multi-level influences in SDM.

Main Methods:

  • Conceptual analysis of existing SDM models.
  • Application of complex intervention frameworks.
  • Consideration of socioecological models for health influences.

Main Results:

  • SDM involves multiple interacting components influenced by personal, interpersonal, organizational, societal, and policy levels.
  • SDM pathways are non-linear and context-dependent.
  • SDM components are tailorable for personalized care and population-specific outcomes.

Conclusions:

  • Shared decision-making (SDM) must be recognized as a complex intervention.
  • SDM conceptualization should encompass influences across the socioecological model.
  • Developing programme theory and standardized outcomes is crucial for evaluating SDM effectiveness and informing policy.