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July 14, 2008

Shared Decision MakingHave We Missed the Obvious?

Arch Intern Med. 2008;168(13):1368-1370. doi:10.1001/archinte.168.13.1368

A decade ago, we saw little in the medical literature about shared decision making, but that has changed. The last several years have brought a proliferation of literature about shared decision making, participatory decision making, decision aids, and related topics. A recent PubMed search for “shared decision making” resulted in 1891 articles. Although we may be tempted to think that we know all that we need to know about it, the article in this issue of the Archives by Young et al1 adds a twist to the thinking about this somewhat unsettling topic. These researchers not only found that the physicians in their study engaged in very little shared decision making—as many other researchers have also documented27—they also found that a very minor action by patients stimulated a little more sharing of decisions on the part of physicians. This suggests that both parties influence one another, yet we have put most of our research emphasis on the role of physicians in engaging patients, neglecting the interactive nature of sharing between the 2 parties. With this slightly prismatic shift in perspective, I would like to challenge some prevalent notions that arise in conversations about shared decision making.

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