Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient's preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches-one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option-and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems. Patient-centered care has been found to be associated with improved patient outcomes, including improved self-management, patient satisfaction, and medication adherence, and some studies have found evidence for improved clinical outcomes. 2,3 Data from surveys and qualitative and observational research indicate that clinicians often do not take patients' perspectives into account; rather, clinicians often promote or recommend specific treatments rather than consider patients' preferences during the decision-making process. [4][5][6][7] Clinicians are commonly challenged by the diversity of situations that arise in practice when they attempt to implement patient-centered care. For example, providing patient-centered care for a patient at the end of life is very different from counseling a patient with a long-term health condition or providing advice about preventative care. Each situation has different psychosocial, cultural, and medical implications. A key factor is the degree to which a clinical situation has acceptable alternative courses of action, ie, situations of equipoise, 8 or whether there is clear evidence for a preferred course of action. For the patient electing to have a mastectomy or lumpectomy in early breast cancer, equipoise exists about the long-term outcomes. Evidence for a preferred course of action is found for the overweight smoker with diabetes who is encouraged to consider quitting.Clearly, different situations require different communication approaches, and patient-centered approaches for each of these situations have been delineated during the last few decades. We wish to focus this article on 2 specific methods, namely, shared decision making and motivational interviewing. As researchers and practitioners, we also wish to share our experience with both. In this article, we provide guidance for how to apply Glyn Elwyn, MD patient-centered approaches across a range of clinical problems. In doing so, we explore the definitions of shared decision making and motivational interviewing and summarize the evidence on their use. We also consider the overlap between the 2 approaches and discuss how practitioners can flexibly combine them to improve thei...

Tools designed to support collaboration and deliberation about treatment options lead to increased levels of shared decision making.

Option Grids provide a fast and frugal approach to supporting shared decision-making, providing a promising solution to the implementation gap experienced by longer decision aids. On one page they present evidence-based summaries of the available condition-specific treatment options, alongside patients' frequently asked questions, helping patients to discuss the key features, risks and benefits of treatment options in relation to their personal values and preferences. They are designed to be sufficiently brief enough for use in clinical encounters and accessible enough to support a better dialogue between patients and clinicians. The Option Grid Collaborative was formed in 2009 and operates on a not-for-profit basis to manage the development process as well as provide support to around 65 multi-disciplinary stakeholders currently involved in developing Option Grids. The Option Grid website (www.optiongrid.org) hosts 13 Option Grids and there are a further 31 Option Grids in development as of January 2013. This paper provides guidance for individuals or teams who are interested in facilitating shared decision-making using short tools on how to develop an Option Grid.

After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways.