Shared Decision-Making Isn’t Stuck, It’s Misunderstood
Post Date: September 22, 2025 | Publish Date: Feb. 14, 2025
The future of shared decision-making depends less on when we should use it and more on how to do it well.
“Saving Shared Decision-Making,” a recent article co-authored by experts from Cincinnati Children’s James M. Anderson Center for Health Systems Excellence and peer institutions, argues that progress in shared decision-making (SDM) has been hindered by a persistent misconception: that SDM only applies when there is clinical equipoise, which means two or more treatment options with similar medical outcomes. The authors propose a new path forward, one that shifts the field’s attention from trying to define when SDM is appropriate to learning how to implement it effectively across diverse clinical contexts.
“Equipoise is neither a necessary nor sufficient criterion in determining the need for SDM,” the authors write. Instead, they call for a focus on developing adaptable skills, tools, and strategies for making SDM work in real-world practice.
Rethinking Equipoise
Equipoise, commonly understood as a balance between treatment options in SDM, is often hard to apply in clinical practice because different decision-makers may have different views on whether that balance exists. For example, a family may perceive two viable options with trade-offs, where a clinician might see one clear choice. The assumption that SDM should only occur when there is equipoise leaves clinicians focused on determining equipoise, rather than facilitating shared decisions that align with a patient’s goals, values, and context.
Learning by Doing: The Path Forward
The authors call for a shift in focus. Rather than asking if SDM should be used, healthcare teams should ask how to do it well. Progress depends on:
- Understanding how SDM is currently practiced and how it impacts patient outcomes
- Evaluating the limitations of decision aids and how they fit into clinical workflows
- Supporting clinicians in developing essential skills like setting goals, clarifying preferences, and communicating trade-offs
Clarifying SDM’s Role
SDM overlaps with informed consent and patient-centered care, but it serves a distinct purpose. It helps ensure care decisions align with what matters most to the patient and family. Clear definitions and consistent application across diverse patient populations and care settings are necessary to advance SDM’s effectiveness
Looking Ahead
As the paper makes clear, SDM is not a static concept waiting for better definitions. It’s a set of practices that must be adapted to real-world care. For SDM to truly deliver on its promise, we must stop asking whether it applies and begin asking how to do it better in every relevant clinical context.
About the paper
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| Original title: | Saving Shared Decision-Making |
| Published in: | Journal of General Internal Medicine |
| Publish date: | Feb. 14, 2025 |
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The Research Horizons blog features news and insights about the latest discoveries and innovations developed by the scientists of Cincinnati Children's. This blog does not provide medical advice, diagnosis, or treatment. Email researchnews@cchmc.org with questions or ideas.
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