Shared decision making and physical therapy: What, when, how, and why?

Background
Shared decision making is a means of translating evidence into practice and facilitating patient-centred care by helping patients to become more active in the decision-making process. Shared decision making is a collaborative process that involves patients and clinicians making health-related decisions after discussing the available options; the benefits and harms of each option; and considering the patient's values, preferences, and personal circumstances.

Methods
This paper describes what shared decision making is, why it is important, when it is appropriate, and key elements. We report on physical therapists’ current use of and attitudes to shared decision making and explore factors that influence its uptake. Lastly, we examine what is needed to promote greater use of this approach.

Results
Key elements in the shared decision making process are: identifying the problem that requires a decision; providing an explanation of the health problem, including, where appropriate, the natural history of the condition; discussing the available options and the potential benefits and harms of each option; eliciting the patient's values, preferences, and expectations; and assisting the patient to weigh up the options to reach an informed decision. When applied in practice, shared decision making has been found to improve patient-clinician communication; improve patients’ accuracy of their expectations of intervention benefits and harms, involvement in decision-making, and feeling of being informed; and increase both patients’ and clinicians’ satisfaction with care.

Conclusion
Despite physical therapists’ enthusiasm for shared decision making, uptake of this approach has been slow. Multi-level strategies and behaviour change are required to encourage and support the sustainable incorporation of shared decision making in practice.