This report, published by the JAMA Network, explores how shared decision making occurs when patients and clinicians reach a formulation about the presenting problem and discuss how to manage it. If there are several reasonable alternatives, the alternatives should be explicitly compared, using evidence about relevant harms and benefits. Such decisions should be informed by knowledge about the patients’ condition, about the evidence applicable to it, and the patient’s goals and preferences. Eliciting patients’ views has been referred to as making a preference diagnosis, and eliciting it requires a blend of science and interpersonal skills.
It is essential to understand a patient’s preferences, including the role he or she wants to play in decision making. Without a sense of what each patient prefers, it is impossible to provide care that fits the individual’s situation. When medical evidence does not support a single option, patients should be informed about treatment alternatives in ways that are easy to grasp.
A redirection of effort from the generation of multiple guidelines and systematic reviews toward forms of evidence synthesis that can be easily and directly applied to individual patient encounters would be desirable. Accurately presenting the potential harms, benefits, and uncertainties to support a collaborative dialogue is an essential task of evidence-based medicine.