Shared Decision Making

Shared Decision Making is a collaborative process where doctors and patients work together to pick tests, treatments, care management based on clinical evidence and a patients’ informed preferences and values. It recognises that there are one than more way to treat a problem, this includes ‘no treatment. Patients could need the help of their doctor or provider to weigh up the benefits and harms of the options before they make the best choice for them.

A fundamental aim of Choosing Wisely is to use the shared decision-making approach to reducing unnecessary tests and treatments. Because of this many of the recommendations are linked to decision aids, which aims to support patients to have the necessary conversations with your patients.

Evidence suggest that patients benefit from SDM, improving the quality and appropriateness of clinical decision making. A Cochrane Review of 115 randomised control trials found that use of patient decision aids leads to improved knowledge and more accurate risk perceptions among patients, greater participation in decision-making, and more appropriate treatment decisions. This will include reduced demand for some screening procedures, such as PSA tests and surgical procedures, such as hysterectomies and knee replacement operations.

This strategy is also effective for tackling overdiagnosis and overtreatment.  For example, interventions to promote SDM, including SDM skills training, have been shown to lead to reductions in inappropriate antibiotic use in acute respiratory infections and a better understanding of the risk of over-detection in breast screening.

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