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Invited Commentary
Less Is More
February 2015

Shared Decision-Making: Easy to Evoke, Challenging to Implement

Author Affiliations
  • 1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
JAMA Intern Med. 2015;175(2):167-168. doi:10.1001/jamainternmed.2014.4606

In this issue of JAMA Internal Medicine, 2 poignant accounts of experiences with breast cancer screening are presented: that of a 40-year-old trying to engage her physician in shared decision-making regarding mammography, which she ultimately decides to forgo,1 and the account of an 83-year-old who has the test, perhaps without realizing it was being offered and not necessarily recommended, and has an abnormal finding.2 In both, a central component of patient-centered care is missing: elicitation of patient preferences and values as part of a shared decision-making process. While the need for shared decision-making is easy to evoke, it can be challenging to implement. How do clinicians decide which among the myriad clinical decisions they face each day warrant a shared decision-making approach? And how can they integrate shared decision-making into busy practices?