Myths and misconceptions of shared decision making

This article, by Nami Nelson, Dawn Stacey, and Sophie Hill, was originally published on April 20, 2020 on the Shared Decision Making in Healthcare blog. The blog has now been archived and is no longer accessible.

In November 2019 and March 2020, Professor Dawn Stacey, Ottawa University, led the Implementing Shared Decision Making Workshops Part 1 and Part 2 as part of the Victorian Shared Decision Making (SDM) pilot project. It was clear in the workshop evaluations that most participants had a preconceived understanding of what SDM is, but after the training a significant number of participants described how they now realised it encompassed much more than they had expected or realised. Some of the anecdotal reports from participants highlighted their realisation that SDM is focused on a supported, informed decision making process rather than the decision outcome itself. To help SDM project teams explain or dispel any misconceptions of misunderstandings about SDM, we asked Professor Stacey to describe some of the most common ones she has come across in her work:

Misconception: SDM means between 2 or more clinicians:

FALSE. It is not SDM if the patient is not involved in the process. SDM is a process where decisions are made between the clinician and their patient/patient’s family. For some decisions, there may also be multiple clinicians discussing the decision with the patient (e.g., prostate cancer treatment).

Misconception: Shared means discussing benefits/harms of only one option:

FALSE. Discussion of the benefits/harms of only one option is more aligned with informed consent. SDM isn’t focused on getting a patient to agree to the clinician’s preferred option. Instead, SDM involves unbiased discussion about pros/cons of all the options and soliciting patient’s informed preferences.

Misconception: SDM involves telling patients their options and asking them what they want.

FALSE. The patient should not be alone in making the choice. SDM is a process whereby the clinician and patient discuss the benefits/harms of options and what is important to the patient.

Misconception: Patients do not want SDM.

FALSE. Public surveys show that over 90% of the public want to be involved in decisions about their healthcare. But when they receive a new diagnosis, they feel overwhelmed and unable to make a decision. By discussing options with, and helping the patient think about what is important to them, they achieve an active role in making the decision.

Misconception: SDM improves lifestyle behavioural changes.

FALSE. Patients making lifestyle decisions (e.g., losing weight, smoking cessation) typically need support with implementing the chosen option. When patients are involved in choosing the option for high blood pressure, they are more likely to adhere to the chosen option.

For a summary of evidence that helps dispel the most common myths and misconceptions about SDM, Professor Stacey recommends “12 myths of Shared Decision Making” (Legare & Thompson-Leduc, 2014).