Patient involvement in healthcare decision-making means patients have a meaningful opportunity to understand their options and contribute what matters to them. It does not mean asking people to make complex clinical decisions alone, or shifting responsibility for care onto them. In shared decision-making, the clinician brings medical expertise and evidence; the patient brings their goals, experiences, preferences, and circumstances. They use both perspectives to decide together when more than one reasonable option exists.
When is shared decision-making useful?
Shared decision-making is especially relevant for preference-sensitive decisions—situations where more than one medically reasonable option may fit, and the best choice depends partly on how the patient weighs possible benefits, harms, burdens, and uncertainty. Examples can include comparing treatment approaches, considering screening options, or deciding whether to start a long-term medicine. The appropriate options depend on the individual case; the clinician should explain when an option is not medically suitable.
Some decisions are urgent, and some patients may prefer to delegate more of the decision to their care team. Involvement should be offered and adapted to the person’s preference, not imposed as another obligation.
What meaningful involvement can look like
- The care team asks what role the patient wants in the decision and whether they would like someone they trust to join.
- The clinician explains the condition and the reasonable options, including waiting or no treatment when clinically appropriate.
- Benefits, harms, side effects, time requirements, and uncertainty are described in plain language and in a balanced way.
- The patient is invited to share goals and constraints—for example, symptom priorities, work or caregiving needs, cost concerns, or comfort with risk.
- Questions are welcomed, understanding is checked, and the plan reflects the patient’s informed preferences and clinical needs.
A practical conversation framework
AHRQ’s SHARE Approach offers a clinician-led structure for shared decisions: seek the patient’s participation, help them compare options, assess what matters most, reach a decision together, and evaluate the decision. A visit does not need to sound scripted. These steps can help keep the discussion collaborative and focused.
1. Invite the patient into the choice
Make clear that a decision is being considered and ask how much the patient would like to participate. Some people want to review detailed evidence; others prefer a concise explanation and a recommendation. Both preferences can be respected while ensuring the person has an opportunity to ask questions and consent to care.
2. Explain and compare reasonable options
Describe the likely benefits and downsides of each appropriate option, including what may happen if the patient waits or chooses no intervention when that is a reasonable path. Use absolute numbers and a consistent denominator when reliable estimates are available, and explain what those numbers do—and do not—mean for the individual. A patient decision aid can help organize information, but it should support conversation rather than replace it.
3. Ask what matters in the person’s life
Open questions can reveal priorities that may not appear in a chart: “What matters most as you think about these choices?” or “Is there anything that would make one option harder to manage?” Do not assume a patient’s goals from age, diagnosis, culture, or family role.
4. Check understanding and make a plan
Teach-back is a way to check how clearly information was explained, not to test or blame a patient. For example: “I want to make sure I explained this clearly. Could you tell me how you understand the options and what we decided?” If something is unclear, explain it another way and invite more questions. Confirm next steps, who will do them, and when the decision can be revisited.
