Table 4

Shared decision-making in clinical practice and associated measurement challenges

Observations of SDM in clinical practiceMeasurement challenges
SDM is distributed over people and time.SDM often involves different healthcare professionals and multiple consultations, especially in long-term conditions, for example, how many interactions (appointments/telephone calls) and with which clinicians?SDM measurement tools are often based on theoretical models of SDM and require that all SDM stages are covered within one encounter. However, clinicians continually adapt their SDM approach to match the patient journey and a consultation which does not cover all aspects of SDM is not necessarily reflective of a poor SDM encounter.
Individuals using scores from an SDM encounter need to be aware of the patient’s journey through the health system.
SDM involves multi-staged decisions.Patients are often required to make multiple decisions in relation to one condition, resulting in the decision-making process not being discrete or orderly.SDM measurement tools generally focus on the process of reaching one particular decision. In the absence of discrete and orderly decisions, together with the increasing incidence of patients with comorbidities, it raises the question of ‘which decision are we measuring?
SDM is adapted to context.The content of SDM consultations will vary based on the nature of the decision, for example, short term versus long term, the patient’s emotional response, previous knowledge and experiences of the treatment options.Careful interpretation of measures is needed because a low item score does not necessarily mean a poor SDM consultation occurred; it might reflect the modification of content based on the context.
  • SDM, shared decision-making.