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Shared decision making: what do clinicians need to know and why should they bother?


Lucille is a 2.5-year-old who has had a cold for 3 days. Last night, it became worse — Lucille was restless and had a fever. Her mother was up with her for much of the night, and she settled eventually with paracetamol. The mother and Lucille come to see you today and both look exhausted. The only positive findings on clinical examination are a congested nose and bulging red left ear drum. You diagnose acute otitis media. “OK”, you say, “Lucille has a middle ear infection”. Her mother asks, “What can be done to help her?”

Shared decision making is a consultation process where a clinician and patient jointly participate in making a health decision, having discussed the options and their benefits and harms, and having considered the patient’s values, preferences and circumstances. Shared decision making is not a single step to be added into a consultation, but can provide a framework for communicating with patients about health care choices to help improve conversation quality. It is a process that can be used to guide decisions about screening, tests and treatments. It can also be thought of as a mechanism for applying evidence with an individual patient through personalising the clinical decision. Although, to date, most research about shared decision making has focused on medical practitioners, it is relevant to clinicians of all disciplines, including nursing…