Shared decision making and chronic diseases

Chronic diseases are the major cause of death anddisability worldwide. Healthcare systems are reformingthemselves to improve the health of people with, or atrisk of developing, chronic diseases. One of the majorgoals of these health reforms is to provide both self-management support and decision support to patientsso that they become involved and informed [1]. “Shareddecision making” (SDM) is described as a process inwhich the health professional and patient go through allphases of the decision-making process together and inwhich they share the preference for treatment and reachan agreement on treatment choice [2]. It has been posi-tioned between a paternalistic model, where the healthprofessional assumes the leading role in treatment deci-sion-making, and an informed patient choice modelwhere the health professional’s role is limited to provid-ing information and the patient is responsible for treat-ment decision-making [3].SDM is recommended because of its potential toimprove the quality of the decision-making process ofpatients for treatment choices that are informed andvalue-based, adherence to treatment decisions and ulti-mately, patient outcomes. It is one of the elements com-monly considered important in patient-centered care, agold standard to improve thequality of chronic diseasecare. Recently, SDM has also been advocated as a promis-ing strategy to promote effective knowledge translation(KT) between patients and their health care provider. Inthat context, a SDM approach to KT is defined as a pro-cess that is embedded in a specific relationship and bywhich both the health care provider and the patient influ-ence each other’s cognitions, emotions and behaviours,and come to agreement about a decision [4]. Althoughthere is a growing clinical interest in SDM, it is still notwidely adopted by health professionals.Frequently reported barriers include time constraints,lack of applicability due to patient characteristics and lackof applicability related to the clinical situation. Otherwise,factors such as the health professional’s motivation, posi-tive impact on the clinical process, and positive impact onpatient outcomes are often reported as facilitating theadoption of SDM [5]. Theory-based approaches are sug-gested to better inform the design of SDM implementationinterventions, as they provide insights on factors that mayinfluence the adoption of SDM by health professionalsandpatientsinagivencontext.Inconclusion,SDMisincreasingly regarded as an ideal chronic disease care strat-egy. SDM may enhance adherence to treatment decision,which is a major public health issue in chronic care.