Shared Decision Making: How to Weigh Options With Your Doctor

Your clinician lays out two or three options and asks, "What would you like to do?" You may feel relieved to have a say, or you may feel unsure. You may wonder how you are supposed to choose when they are the expert. This is shared decision making. This guide explains what it is, why it matters, and how to take part with confidence.

What shared decision making is

Shared decision making is a process where you and your clinician make a health decision together. It combines two kinds of expertise. [1] [3]

• Your clinician knows the evidence: the options, the likely benefits, and the risks.
• You know your life: your goals, your worries, your daily routine, and what matters most to you.

Neither side has the full picture alone. A good decision needs both.

When it matters most

Shared decision making is most useful when there is more than one reasonable option. [1] This is common when:

• The evidence is uncertain.
• The benefits and harms are closely balanced.
• Options have very different side effects, costs, or demands on your time.
• A guideline gives a weak or conditional recommendation, which means the right choice depends on your values. [5]

Examples include choosing between active surveillance and surgery for low risk prostate cancer, deciding when to start breast cancer screening, or choosing whether to take a medicine to prevent a future problem.

When one option is clearly best for almost everyone, such as treating a serious infection, there is less to share. But your clinician should still explain the plan and listen to your concerns.

A simple model

One widely used model describes three steps. [1]

Choice talk

Your clinician makes it clear that there is a choice to make, and that your view matters. They may say, "There are a few reasonable options here, and the best one depends on what matters to you."

Option talk

Your clinician explains each option, including doing nothing or waiting. They describe the benefits and harms of each, ideally in numbers that are easy to understand, such as "out of 100 people like you". [1]

Decision talk

You talk about what matters to you, and together you reach a decision. You can take time to think, talk with family, or come back later if the decision is not urgent. [1]

What doctors look at

Clinicians use evidence and tools to support shared decisions. [2] [3]

• Guideline recommendations and their strength.
• Your personal risk, often from a risk calculator.
• Absolute numbers for benefits and harms.
• Decision aids for the specific choice.
• Your preferences, goals, and practical constraints.

NICE in the United Kingdom has a guideline on shared decision making. It asks clinicians to discuss benefits, risks, and consequences of each option, including doing nothing, and to check that people have understood. [3]

Decision aids

A decision aid is a tool, such as a leaflet, a video, or a website, that explains options and helps you think about your values. Many are free. The Ottawa Hospital Research Institute keeps a public inventory of decision aids that meet quality standards. [4]

A large Cochrane review of more than 200 studies found that people who used decision aids: [2]

• Knew more about their options.
• Had a more accurate sense of their risks.
• Felt less conflict about their decision.
• Were more likely to make a choice that matched their values.
• Took a more active role in decisions.

Decision aids did not seem to cause harm or make people less satisfied. [2]

How to prepare

You can do a lot before your visit.

• Write down the decision you need to make.
• List the options you know of, including waiting.
• Think about what matters most to you: living longer, avoiding side effects, staying active, cost, time away from work, or something else.
• Ask whether a decision aid exists for your choice.
• Bring someone you trust to help listen and ask questions.

During the visit

• Tell your clinician how involved you want to be.
• Ask for numbers out of 100 people, not only percentages.
• Say what matters to you, even if it seems small.
• Ask what they would suggest for someone with your values.
• Summarize what you heard, so you can check that you understood.

Common worries

Many people feel unsure about sharing a decision. These worries are normal.

• "I do not know enough." You do not need medical training. You only need to know what matters to you. Your clinician fills in the medical facts.
• "I might choose wrong." When options are close, there is often no single right answer. A good decision is one that is informed and fits your values.
• "My doctor will think I do not trust them." Asking questions is a sign that you care about your health. Most clinicians welcome it.
• "I feel rushed." Ask whether the decision can wait. If it can, ask for a follow-up visit or a phone call.

Questions to ask your clinician

• What are all my options, including waiting or doing nothing?
• What are the benefits and harms of each option for someone like me?
• How likely are those benefits and harms, in numbers out of 100?
• How strong is the evidence for each option?
• Is there a decision aid I can use?
• How soon do I need to decide?
• Can I change my mind later?

Bottom line

Shared decision making means you and your clinician choose together. Your clinician brings the evidence, and you bring your values and life. It matters most when there are several reasonable options. Decision aids help people understand their choices and feel more sure. Prepare your questions, say what matters to you, and take time when you can.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.