Shared Decision-Making in Mental Health Care - SAMHSA Store ...

47Background: Definitions of SDM and Related TermsMultiple SDM DefinitionsThere is no single agreed-upon definition of shared decision-making (SDM). A varietyof decision-making terms are used in the literature to refer to similar concepts, yetthey also lack consistent definitions. Examples include: empowerment, patient participationand involvement, person- and patient-centered, self-directed care, self-caremanagement, and patient activation (Elwyn, Edwards, Kinnersley, & Grol, 2000;Makoul & Clayman, 2006; Trevena & Barratt, 2003). “Empowerment” essentiallyrefers to consumer 1 activation via the acquisition of specific knowledge and skillsneeded by a person to enact health behaviors. “Person-centered” interventions focuson the actions of the service provider (instead of the consumer) to achieve outcomes.“Self-directed care” or “self-care management” focuses on what an individual doesto manage their own health condition but without necessary reference to the serviceprovider role.By contrast, SDM can be defined as an interactive, collaborative process betweenproviders and consumers that is used to make health care decisions, in which atleast two individuals work together as partners with mutual expertise (professionaland experiential) to exchange information and clarify values in relation to optionsand thereby arrive at a discrete decision (Adams & Drake, 2006; Deegan & Drake,2006; Hook, 2006; Simon, Loh, Wills, & Harter, 2007). SDM process steps include:(1) recognition that a decision needs to be made; (2) identification of the partners inthe process as equals; (3) statement of options as equal; (4) exchange of informationon pros and cons of options; (5) exploration of understanding and expectations; (6)identifying preferences; (7) negotiating options and concordance; (8) sharing thedecision; and, (9) arranging followup to evaluate decision-making outcomes (Simonet al., 2006).Decision-making itself is a process of making a choice (decision) from among twoor more discrete options (Wills & Holmes-Rovner, 2006). Adams and Drake (2006)characterize the provider role in SDM as, “the practitioner becomes a consultant tothe consumer, helping to provide information, to discuss options, to clarify valuesand preferences, and to support the consumer’s autonomy” (Adams & Drake, 2006,p. 90). SDM can decrease the informational and power imbalance between the practitionerand the consumer by increasing the consumer’s information, autonomy, orcontrol over health care decision-making (Charles, Gafni, & Whelan, 1997, 1999).SDM ideally provides a supportive encounter in which the partners clarify theirvalues and preferences in relation to the information and options (Wills & Holmes-1Editorial notation will be used throughout this paper to show adherence to recommended language styles reflectiveand supportive of People First Language. See http://www2.ku.edu/~lsi/news/featured/guidelines.shtmlfor further discussion.Shared Decision-Making in Mental Health Care:Practice, Research, and Future Directions