• Research

    Let’s focus on the problem: Purposeful shared decision making in medicine

By Lydia Hansen, undergraduate public affairs intern

A doctor discusses health care options with an elderly couple. The male patient lies in a hospital bed.

Shared decision making between patients and providers plays a crucial role in health care experiences and outcomes. However, each patient and each health care experience is unique, so no one approach to shared decision making is appropriate in all situations.

In a recent paper published in Patient Education and Counseling, a team of Mayo Clinic researchers advocate for a problem-based approach that adapts shared decision making to patients’ problems.

Purposeful shared decision making

“There are many different ways that decisions can be shared between patients and providers, depending on the situation,” says Ian Hargraves, first author on the paper. 

In recent years, says Dr. Hargraves, models of shared decision making discussed in the literature have focused on securing patient involvement in decision making with less attention on the purpose of that involvement—why each patient and their clinician are making a decision and in response to what problem. “The purpose should come first,” says Dr. Hargraves.

In the paper, the researchers call their problem-based approach “purposeful shared decision making.”  The important thing about this approach, they say, is the decision making varies according to what the patient is experiencing in their illness, treatment, and life.

The paper’s authors identify four kinds of situations in which shared decision making is often needed. Each of these requires different methods of shared decision making.

PurposeShared decision making methodExample
Choosing between alternativesWeigh pros and consChoosing between two medications
Choosing between different desiresIntrapersonal or interpersonal negotiationChoosing the method of childbirth right for you
Managing a difficult health care situationUse conversation to problem solve. Test hypotheses to determine the nature of the situation and how best to resolve it. Dealing with the intellectual, practical and emotional challenges of a family member's serious illness
Deciding what matters most when it comes to healthUse dialogue to bring people together and create shared meaningFacing an important life transition, such as a death

In the purposeful shared decision making model, how and to what extent patients and clinicians participate in decision making changes with the situation, the method of shared decision making that they’re using, as well as the people involved. Shared decision making goes beyond involving patients, it involves a delicate dance to find the right way to interact so that each can best contribute to resolving the patient’s situation.

Research can help orient shared decision making to the practice

Shared decision making is being required of clinicians more and more at all levels of health care, says Dr. Hargraves.  Research into new models, like purposeful shared decision making, he asserts, will help shape the way that these approaches are integrated into everyday patient care. 

“We need to develop interventions and ways to support and train clinicians in using and understanding the variety of shared decisions making methods and the situations where they apply,” Dr. Hargraves says.

In addition, he calls for further research on patient-physician communication to identify situations where the four approaches to shared decision making are already being used as part of everyday practice. A more comprehensive understanding, he says, will help researchers develop better models and better measures of quality and success.

Learn more about Mayo’s research on shared decision making in health care