Research in Shared Decision Making

Frameworks and Models in Shared Decision Making

Several frameworks and models of shared decision making (SDM) have been developed to describe the essential elements and core processes of SDM and how they can be achieved in clinical practice. Below we cite three commonly used models:

Three-Talk Model for SDM

Glyn Elwyn, et al. describe three key steps of SDM for clinical practice, which they name: Team Talk, Option Talk, and Decision Talk. During Team Talk the care team describes choices, offers support, and asks about goals. Option Talk involves comparing options using risk communication principles. Finally, Decision Talk is the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of the care team.

The SHARE Approach

The SHARE Approach is a generalized SDM model that streamlines the nine essential steps of SDM identified by Makoul and Clayman, each represented by a letter of the SHARE mnemonic (Seek, Help, Assess, Reach, Evaluate). The SHARE Approach model is supported by a training workshop curriculum for clinicians emphasizing how to carry out each step of SDM, basic communication skills, and the use of evidence and tools to inform decisions. 

Purposeful SDM

Hargraves, et al.'s Purposeful SDM framework identifies four distinct deliberative processes used in collaborative decision making: (1) weighing options; (2) negotiating conflicting intra- or interpersonal points of view, desires, or agendas; (3) problem solving multiple interacting situational factors; and (4) developing the insight needed to act. This model focuses on the "problems that lead patients and clinicians to be interacting in the first place" and broadens SDM to include the many circumstances where patients and clinicians must navigate decisions together that are not related to evidence-based options.  

AHRQ and the Mayo Clinic have collaborated to adapt The SHARE approach to the different problems that patients face as they are described in Purposeful SDM.

See Generalized shared decision making approaches and patient problems. Adapting AHRQ’s SHARE approach for Purposeful SDM.

AHRQ also currently funds a research grant that aims to develop an observer-based measure of SDM occurrence ("SDMo") based on the purposeful SDM framework. 

AHRQ-funded Published Work in SDM

AHRQ has supported SDM research for nearly 30 years. Through advances in SDM research, AHRQ hopes to promote changes to healthcare practice that support patient autonomy in healthcare decisions while valuing the critical role clinical teams play in making sure patient decisions are informed by the best evidence. AHRQ-funded SDM research has been conducted in multiple healthcare settings, including primary care, specialty, hospital, and emergency, and has focused on patients with a variety of diseases or conditions. AHRQ has supported research to:

• develop and test tools, such as paper-, video-, electronic health record-, and digital-based decision aids
• develop and test training interventions for facilitating or implementing SDM in practice
• understand SDM implementation barriers, facilitators, and contextual factors to inform interventions and implementation strategies 
• develop measures that evaluate the presence of SDM during clinical encounters

Selected AHRQ-funded publications

AHRQ-funded SDM grants have produced more than 300 publications.  You can find them by visiting PubMed and searching "AHRQ HHS/United States[Grant Number] and shared decision making." Below are several recent publications that highlight the work of some of AHRQ's grantees.

• Implementing lung cancer screening in primary care: needs assessment and implementation strategy design. (2022)
• Is Shared Decision-making Associated with Better Patient-reported Outcomes? A Longitudinal Study of Patients Undergoing Total Joint Arthroplasty. (2022)
• Show Me the Money: Patients' Perspectives on a Decision Aid for Sacubitril/Valsartan Addressing Out-of-Pocket Cost. (2020)
• Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure. (2022) 
• "This is not negotiable. You need to do this…": A directed content analysis of decision making in rehabilitation after knee arthroplasty. (2021) 

SDM Learning Community

Many of AHRQ's funded SDM studies are the result of researchers applying to general funding announcements. The SDM Team at AHRQ brings together a number of these researchers to learn and share with one another. Participants share implementation challenges, identify and discuss SDM research issues and opportunities for improvement and advancement, and occasionally invite other experts in the field to lead topical discussions.