Saving Shared Decision-Making

doi:10.1007/s11606-025-09410-z

Editorial

. 2025 Jun;40(8):1844-1847.

doi: 10.1007/s11606-025-09410-z. Epub 2025 Feb 14.

Saving Shared Decision-Making

Douglas J Opel¹, Maya T Gerstein², Adam C Carle^{3

4}, Alaina K Fournier², Ian Hargraves⁵, Jennifer E Lafata⁶, Ellen A Lipstein^{3

4}, Trudy Mallinson⁷, Nathalie Moise⁸, Heather B Neuman⁹, Mary Nix², Christina Papadimitriou¹⁰, Laura Scherer¹¹, Karen Sepucha¹², Matthew Simpson², Alan Schwartz¹³, Jennifer E Stevens-Lapsley¹¹, Neal W Dickert¹⁴

Affiliations

¹ Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA. douglas.opel@seattlechildrens.org.
² Agency for Healthcare Quality and Research, Rockville, MD, USA.
³ James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁴ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
⁵ Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
⁶ Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
⁷ George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
⁸ Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
⁹ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁰ Oakland University School of Health Sciences, Rochester, MI, USA.
¹¹ University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
¹² Massachusetts General Hospital, Boston, MA, USA.
¹³ Departments of Medical Education and Pediatrics, University of Illinois, Chicago, IL, USA.
¹⁴ Emory University School of Medicine, Atlanta, GA, USA.

PMID: 39953310
PMCID: PMC12119428 (available on 2026-06-01)
DOI: 10.1007/s11606-025-09410-z

Editorial

Saving Shared Decision-Making

Douglas J Opel et al. J Gen Intern Med. 2025 Jun.

. 2025 Jun;40(8):1844-1847.

doi: 10.1007/s11606-025-09410-z. Epub 2025 Feb 14.

Authors

Affiliations

¹ Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA. douglas.opel@seattlechildrens.org.
² Agency for Healthcare Quality and Research, Rockville, MD, USA.
³ James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁴ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
⁵ Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
⁶ Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
⁷ George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
⁸ Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
⁹ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
¹⁰ Oakland University School of Health Sciences, Rochester, MI, USA.
¹¹ University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
¹² Massachusetts General Hospital, Boston, MA, USA.
¹³ Departments of Medical Education and Pediatrics, University of Illinois, Chicago, IL, USA.
¹⁴ Emory University School of Medicine, Atlanta, GA, USA.

PMID: 39953310
PMCID: PMC12119428 (available on 2026-06-01)
DOI: 10.1007/s11606-025-09410-z

Abstract

The Agency for Healthcare Research and Quality encouraged a re-examination of the concept, process, and measurement of shared decision-making (SDM) in 2016. Progress, however, has been slow. One illustrative example is SDM's relationship with the concept of equipoise: there remains little consensus on what equipoise means in the context of SDM, creating confusion about when SDM is and is not indicated. In this paper, we describe the ways in which this focus on equipoise in SDM is counter-productive and argue that equipoise is neither a necessary nor sufficient criterion in determining the need for SDM. Moreover, we suggest that what is needed to move the field of SDM forward is a shift away from focusing on when SDM is needed to instead focusing on how best to accomplish SDM across a variety of contexts by advancing the science of SDM implementation.

Keywords: health communication; medical ethics; patient preference; shared decision-making.

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Conflict of interest statement

Declarations:. Conflict of Interest:: All authors have fully disclosed all potential conflicts of interests through submission of the International Committee of Medical Journal Editors conflict of interest form to the Journal. Ethics Approval:: N/A. Consent to Participate:: N/A. Consent to Publish:: N/A.

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Mertens L, Vandenberghe J, Bekkering G, Hannes K, Delvaux N, Van Bostraeten P, Jaeken J, Aertgeerts B, Vermandere M. Mertens L, et al. Health Expect. 2025 Apr;28(2):e70239. doi: 10.1111/hex.70239. Health Expect. 2025. PMID: 40193150 Free PMC article. Review.

References

1. Merchant FM, Dickert NW, Jr., Howard DH. Mandatory Shared Decision Making by the Centers for Medicare & Medicaid Services for Cardiovascular Procedures and Other Tests. JAMA 2018;320(7):641-642. 10.1001/jama.2018.6617 - PubMed
1. Agency for Healthcare Research and Quality. Funding Opportunity Announcement (FOA) Guidance. Accessed June 2, 2018. Expired PA-16–424: Developing Measures of Shared Decision Making (R01): https://www.ahrq.gov/grants/guide/pa-files/PA-16-424.html
1. Bomhof-Roordink H, Gartner FR, Stiggelbout AM, Pieterse AH. Key components of shared decision making models: a systematic review. BMJ Open 2019;9(12):e031763. 10.1136/bmjopen-2019-031763 - PMC - PubMed
1. Probst MA, Kanzaria HK, Schoenfeld EM, et al. Shared Decisionmaking in the Emergency Department: A Guiding Framework for Clinicians. Ann Emerg Med 2017;70(5):688-695. 10.1016/j.annemergmed.2017.03.063 - PMC - PubMed
1. Elwyn G, Edwards A, Kinnersley P, Grol R. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract 2000;50(460):892-9. - PMC - PubMed

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[1] Merchant FM, Dickert NW, Jr., Howard DH. Mandatory Shared Decision Making by the Centers for Medicare & Medicaid Services for Cardiovascular Procedures and Other Tests. JAMA 2018;320(7):641-642. 10.1001/jama.2018.6617 - PubMed

[2] Merchant FM, Dickert NW, Jr., Howard DH. Mandatory Shared Decision Making by the Centers for Medicare & Medicaid Services for Cardiovascular Procedures and Other Tests. JAMA 2018;320(7):641-642. 10.1001/jama.2018.6617 - PubMed

[3] Agency for Healthcare Research and Quality. Funding Opportunity Announcement (FOA) Guidance. Accessed June 2, 2018. Expired PA-16–424: Developing Measures of Shared Decision Making (R01): https://www.ahrq.gov/grants/guide/pa-files/PA-16-424.html

[4] Agency for Healthcare Research and Quality. Funding Opportunity Announcement (FOA) Guidance. Accessed June 2, 2018. Expired PA-16–424: Developing Measures of Shared Decision Making (R01): https://www.ahrq.gov/grants/guide/pa-files/PA-16-424.html

[5] Bomhof-Roordink H, Gartner FR, Stiggelbout AM, Pieterse AH. Key components of shared decision making models: a systematic review. BMJ Open 2019;9(12):e031763. 10.1136/bmjopen-2019-031763 - PMC - PubMed

[6] Bomhof-Roordink H, Gartner FR, Stiggelbout AM, Pieterse AH. Key components of shared decision making models: a systematic review. BMJ Open 2019;9(12):e031763. 10.1136/bmjopen-2019-031763 - PMC - PubMed

[7] Probst MA, Kanzaria HK, Schoenfeld EM, et al. Shared Decisionmaking in the Emergency Department: A Guiding Framework for Clinicians. Ann Emerg Med 2017;70(5):688-695. 10.1016/j.annemergmed.2017.03.063 - PMC - PubMed

[8] Probst MA, Kanzaria HK, Schoenfeld EM, et al. Shared Decisionmaking in the Emergency Department: A Guiding Framework for Clinicians. Ann Emerg Med 2017;70(5):688-695. 10.1016/j.annemergmed.2017.03.063 - PMC - PubMed

[9] Elwyn G, Edwards A, Kinnersley P, Grol R. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract 2000;50(460):892-9. - PMC - PubMed

[10] Elwyn G, Edwards A, Kinnersley P, Grol R. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract 2000;50(460):892-9. - PMC - PubMed

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