When Guidelines Recommend Shared Decision-making

Clinicians and patients may develop care plans from clinical practice guidelines. To be trustworthy, guidelines should result from a rigorous, inclusive, and transparent process, informed by the best available research evidence and safeguarded against biases and conflicts of interest.¹ Their guidance should be clear, specific, graded by likelihood of benefit and harm, and actionable. Guidelines are increasingly recommending shared decision-making (SDM),² an approach in which patients and clinicians work together to develop a shared appreciation of the patient’s situation and decide how to respond well to it.³ The increasing recommendation of SDM in guidelines is problematic insofar as the extent to which the guideline recommendations are reliable, useful, usable, and desirable remains unclear.