Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

Abstract

Background Shared decision‐making (SDM) takes place when clinicians help patient identify best course of action in the context of their preferences. Methods The aim of this paper is a narrative review of the literature with special focus on the humanistic dimensions of SDM. Results We show that SDM is largely underused in practice, because of many barriers such as time constraints and poor skills. Conclusions We suggest that listening and empathy are key challenges in communicating uncertainty, which require emotional intelligence and trust building skills. To promote implementation, we propose the development of tools, simulation‐based training and the design of improved measures for SDM quality. While essential for patients, we believe that SDM may restore meaning in healthcare.

“I know my body better than you:” patient focus groups to inform a decision aid on oral corticosteroid use during pregnancy

“…These include being proactive in discussing medication use during pregnancy, making responsive treatment recommendations, striving for patient understanding, taking a holistic view of maternal and fetal well‐being, and engaging in counseling skills, for example, exhibiting empathy. These provider factors, requiring cognitive and emotional skill, may be integral to meaningful shared decision making about medication use during pregnancy 53 …”

Shared Decision-Making for Patients Using Cannabis for Pain Symptom Management in the United States

“…While much of the literature on SDM has focused on specific steps or techniques, it is important to recognize that the order of the steps is less important than the spirit in which mutual planning occurs. Experts have postulated that empathy is the most important step of SDM, and that it can and should be employed at every stage of the interaction (Stalnikowicz, & Brezis, 2020). One SDM framework is being applied to clinician decision-making regarding prescribing cannabis in Canada (Allan et al, 2018).…”

Implementation of a diagnostic decision aid for people with memory complaints and their general practitioners: a protocol of a before and after pilot trial

“… 30 Implementing SDM specific for people with memory complaints is additionally expected to be challenging because people with memory complaints and their significant others sometimes have conflicting views regarding initiating a diagnostic process due to denial, fear or a lack of perceived need. 31 Moreover, participation in SDM requires certain cognitive skills that people with memory complaints might be lacking 32 …”