Toward an operational definition of shared decision making: A conceptual analysis
David W. Chambers
Abstract
RATIONALE: Shared decision making has been widely advocated and evaluated in diverse ways for 4 decades. AIMS AND OBJECTIVES: But there is scant evidence that it is commonly accepted by or has influence on practitioners' behaviour or that it positively affects patient health outcomes. This situation may be due in part to the absence of a commonly agreed operational definition of the construct. This is admitted in the literature and has led to multiple approaches to evaluation. METHOD: An operational definition is proposed based on ethical parity among parties, sharing of mutually interacting expectations and analysis of decisions as commitment to action rather than information. RESULTS: Shared decision making occurs when two autonomous and uncoerced agents both commit to actions that neither has reason to want to change based on their understanding of anticipated outcomes given the situation at hand and of the intended actions of the other party. CONCLUSION: It is a broader concept than providing information regarding treatment alternatives in the office.