Missing Ingredients in Shared Decision-Making?

  • Anthony J. PavloEmail author
  • Maria O’Connell
  • Steve Olsen
  • Mary K. Snyder
  • Larry Davidson
Original Paper


Shared decision-making (SDM) is a collaborative approach to making decisions in health care, and is a cornerstone of person-centered care. While providers are increasingly expected to utilize SDM in routine practice, widespread and sustainable implementation has proven difficult, especially in the care of individuals diagnosed with serious mental illnesses, and physicians and patients continue to identify barriers to effective collaboration. To date, SDM research has largely focused on the provision of high-quality clinical information from doctors to patients to the neglect of what may be the most important, and transformative, aspect of SDM—the relationship itself. In this forum, the lack of attention to the relationship in SDM research and practice will be explored, along with the relational qualities that need to be in place to implement SDM in the care of persons with serious mental illness based on the findings from a mixed-methods, participatory research project.


Shared decision-making Treatment relationships Patient engagement Chronic illness care 



This project was supported by grant number K12HS023000 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Making health care decisions (Volume 1). President’s Commission for the Study of Ethical Problems in Medicine Biomedical Behavioral Research, 1982, Washington, DC. Accessed 23 January 2017.
  2. 2.
    Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27:1361–7.CrossRefGoogle Scholar
  3. 3.
    Deegan PE, Drake RE. Shared decision making and medication management in the recovery process. Psychiatr Serv. 2006;57:1636–9.CrossRefGoogle Scholar
  4. 4.
    Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73:526–35.CrossRefGoogle Scholar
  5. 5.
    Stiggelbout AM, Van der Weijden T, De Wit M, et al. Shared decision making: really putting patients at the Centre of healthcare. Br Med J. 2012;344:e256.CrossRefGoogle Scholar
  6. 6.
    Hamann J, Mendel R, Cohen R, et al. Psychiatrists’ use of shared decision making in the treatment of schizophrenia: patient characteristics and decision topics. Psychiatr Serv. 2009;60:1107–12.CrossRefGoogle Scholar
  7. 7.
    Stevenson FA, Barry CA, Britten N, Barber N, Bradley CP. Doctor–patient communication about drugs: the evidence for shared decision making. Soc Sci Med. 2000;50:829–40.CrossRefGoogle Scholar
  8. 8.
    Charles C, Gafni A, Whelan T. Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49:651–61.CrossRefGoogle Scholar
  9. 9.
    Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44:681–92.CrossRefGoogle Scholar
  10. 10.
    Saba GW, Wong ST, Schillinger D, Fernandez A, Somkin CP, Wilson CC, et al. Shared decision making and the experience of partnership in primary care. Ann Fam Med. 2006;4:54–62.CrossRefGoogle Scholar
  11. 11.
    Edwards A, Elwyn G. Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision. Health Expect. 2006;9:307–20.CrossRefGoogle Scholar
  12. 12.
    Davidson L, Tondora J, Pavlo AJ, Stanhope V. Shared decision making within the context of recovery-oriented care. Ment Health Rev J. 2017;22:179–90.CrossRefGoogle Scholar
  13. 13.
    Dohan D, Garrett SB, Rendle KA, Halley M, Abramson C. The importance of integrating narrative into health care decision making. Health Aff. 2016;35:720–5.CrossRefGoogle Scholar
  14. 14.
    Tai-Seale M, Elwyn G, Wilson CJ, Stults C, Dillon EC, Li M, et al. Enhancing shared decision making through carefully designed interventions that target patient and provider behavior. Health Aff. 2016;35:605–12.CrossRefGoogle Scholar
  15. 15.
    Hargraves I, LeBlanc A, Shah ND, Montori VM. Shared decision making: the need for patient-clinician conversation, not just information. Health Aff. 2016;35:627–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Medicine, Department of Psychiatry, Program for Recovery and Community HealthYale UniversityNew HavenUSA

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