Saving Shared Decision-Making

Douglas J Opel; Maya T Gerstein; Adam C Carle; Alaina K Fournier; Ian Hargraves; Jennifer E Lafata; Ellen A Lipstein; Trudy Mallinson; Nathalie Moise; Heather B Neuman; Mary Nix; Christina Papadimitriou; Laura Scherer; Karen Sepucha; Matthew Simpson; Alan Schwartz; Jennifer E Stevens-Lapsley; Neal W Dickert

doi:10.1007/s11606-025-09410-z

Saving Shared Decision-Making

J Gen Intern Med. 2025 Jun;40(8):1844-1847. doi: 10.1007/s11606-025-09410-z. Epub 2025 Feb 14.

Authors

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

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.

Publication types

Editorial

MeSH terms

Decision Making, Shared*
Humans
Patient Participation* / methods