Saving Shared Decision-Making

Douglas J. Opel, Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA. douglas.opel@seattlechildrens.org.
Maya T. Gerstein, Agency for Healthcare Quality and Research, Rockville, MD, USA.
Adam C. Carle, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Alaina K. Fournier, Agency for Healthcare Quality and Research, Rockville, MD, USA.
Ian Hargraves, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
Jennifer E. Lafata, Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Ellen A. Lipstein, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Trudy Mallinson, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Nathalie Moise, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Heather B. Neuman, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Mary Nix, Agency for Healthcare Quality and Research, Rockville, MD, USA.
Christina Papadimitriou, Oakland University School of Health Sciences, Rochester, MI, USA.
Laura Scherer, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
Karen Sepucha, Massachusetts General Hospital, Boston, MA, USA.
Matthew Simpson, Agency for Healthcare Quality and Research, Rockville, MD, USA.
Alan Schwartz, Departments of Medical Education and Pediatrics, University of Illinois, Chicago, IL, USA.
Jennifer E. Stevens-Lapsley, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
Neal W. Dickert, Emory University School of Medicine, Atlanta, GA, USA.

Document Type

Editorial

Publication Date

2-14-2025

Journal

Journal of general internal medicine

DOI

10.1007/s11606-025-09410-z

Keywords

health communication; medical ethics; patient preference; shared decision-making

Abstract

The Agency for Healthcare Research and Quality encouraged a re-examination of the concept, process, and measurement of shared decision-making (SDM) in 2016. Progress, however, has been slow. One illustrative example is SDM's relationship with the concept of equipoise: there remains little consensus on what equipoise means in the context of SDM, creating confusion about when SDM is and is not indicated. In this paper, we describe the ways in which this focus on equipoise in SDM is counter-productive and argue that equipoise is neither a necessary nor sufficient criterion in determining the need for SDM. Moreover, we suggest that what is needed to move the field of SDM forward is a shift away from focusing on when SDM is needed to instead focusing on how best to accomplish SDM across a variety of contexts by advancing the science of SDM implementation.

Department

Clinical Research and Leadership

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