While both evidence-based medicine as well as personalized patient-centered medicine are glorified, clinical practice seems to be only partially influenced by guidelines or by patients’ views. Against this background, shared decision-making (SDM) became a hype but remains an ill-defined concept: it can be considered as an umbrella concept covering therapeutic alliance, physician and patient preferences, information giving, information retrieving, information receiving, patient involvement in goal setting, decision-making, and treatment choice.

A narrative review based on a literature search in PubMed and PsycINFO.

SDM in depression should move away from an ethical imperative where “one size fits all” toward a personalized approach, tailoring the medical encounter to the physician’s and patient’s expectations (knowledge, need for knowledge, and desire for degree of SDM) and to the patient’s clinical status. SDM cannot be conceived as a “snapshot” since it is a dynamic process where adjustments should be made depending on the growth of the doctor–patient alliance, the changes in expectations, and the changes in clinical status. The clinician should be more aware of barriers to effective implementation of SDM in him or herself, in the patient. The different definitions of SDM and the many reported SDM interventions (having different ingredients) hamper final conclusions on the effect of SDM on outcomes.

This narrative review aims to critically examine SDM in depression and proposes to conceptualize it as a dynamic, relational, and personalized process rather than a universal ethical standard.

Patients with recurrent breast cancer and liver metastases complicated by hepatic failure have limited treatment options and poor prognoses. Narrative-based medicine (NBM) and shared decision-making (SDM) may support patient-centered decisions even in critical clinical situations

To describe the role of NBM and SDM in guiding treatment decisions for a patient with recurrent breast cancer and diffuse hepatic metastases associated with severe liver dysfunction.

We present the case of a woman with recurrent breast cancer who developed hepatic failure caused by diffuse liver metastases. Repeated SDM discussions were conducted among the patient, her family, and a board-certified breast oncologist with certification in palliative care. Chemotherapy with eribulin was initiated together with intensive supportive care despite life-threatening organ failure.

Following the initial onset of adverse effects, the patient’s liver function improved, allowing continuation of outpatient chemotherapy and fulfillment of her goal of spending meaningful time with family. The patient survived for approximately 5 months after treatment initiation.

This case suggests that individualized care guided by NBM and SDM may support safe and goal-concordant treatment decisions, even near the end of life. Integration of oncologic and palliative expertise may help align medical interventions with patient values and preferences in complex clinical situations.

We aimed to improve the shared decision-making process for those offered antipsychotic medicines by co-designing a suite of accurate and accessible medicines information video resources.

We adopted the four core activities of the Double Diamond Design Thinking Model – Discover, Define, Develop, and Deliver. We first explored the full range of stakeholder needs including pharmacists, psychiatrists, nurses, and most importantly experts-by-experience, in relation to existing antipsychotic medicines information resources. Using a validated tool, we assessed the understandability and actionability of the manufacturer’s patient information leaflets and digital resources accessed following an internet search. Using this information, we refined our insights into a clear problem statement and solution.

We identified gaps in readability, understandability, and actionability with existing antipsychotic medicines information resources. Consequently, we developed prototype information resources that we iteratively reviewed and validated along with our expert panel of key stakeholders. We uploaded our six antipsychotic medicines information videos to our digital platform where they can be freely accessed by those participating in shared decision-making.

Our antipsychotic medicines information videos address an unmet need in the shared decision-making process. Using a human-centred and innovative approach, we prioritised input from key stakeholders to provide clear, accurate, and accessible information to support informed choices in psychosis recovery.

Information about a treatment’s benefits and harms available to a patient often relies on text. However, for many medical conditions, patients must trade off benefits and harms across multiple competing treatments. It remains unknown how to appropriately communicate information on benefits and harms to patients.

We compared three communication tools using textual information (Cochrane summary of findings table) or increasing combinations of textual and graphical information (Kilim and Vitruvian plots, respectively) to convey the available evidence.

Communication of Benefit–Risk Information, an online randomised controlled trial, is a three-group, parallel, open-label, automated, randomised controlled trial (no. NCT05917639). We recruited participants aged between 18 and 65 years from the general population. Participants were randomly allocated (1:1:1) to one of the three communication tools providing information on competing fictional treatments for social anxiety, and were asked to choose one based on externally provided preferences. The primary outcome was the perceived level of decisional conflict when selecting a treatment (decisional conflict scale (DCS): 0 = best, 100 = worst). Because this was an all-or-nothing, single-visit trial, only those participants providing data contributed to the primary analyses (modified intention to treat).

We recruited 2178 adults between 1 June and 27 November 2023. Vitruvian and Kilim plots outperformed the Cochrane summary of findings table on the primary outcome (adjusted mean difference −10.9, 95% CI −13.5 to −8.2, P < 0.0001 and −9.7, 95% CI −12.4 to −7.1, P < 0.0001), respectively). Results varied by participants’ literacy and numeracy skills, lived experience of the condition of interest, ethnic group, gender assigned at birth and age.

Combining graphical and textual information, as opposed to text only, improved communication and reduced decisional conflict when choosing across multiple competing medical interventions. Organisations involved in disseminating scientific evidence should consider endorsing a combined graphical and textual approach and adopting more intuitive and accessible communication methods. We identified several prognostic factors that should inform the development of future patient decision aids and communication of scientific findings.

NCT05917639.

To explore facilitators and barriers to smoking cessation among smokers experiencing socioeconomic disadvantage, from the perspectives of patients and healthcare providers (HP) participating in the STOP randomized controlled trial (STOP-RCT).

Smoking remains disproportionately prevalent among socioeconomically disadvantaged individuals, contributing to significant health disparities. The STOP-RCT evaluates a preference-based smoking cessation intervention offering free nicotine replacement therapy (NRT) and e-cigarettes to disadvantaged smokers.

A qualitative study was conducted involving semi-structured interviews with 14 participants and 5 HP from the STOP-RCT. Data collection explored participants’ smoking cessation experiences, perceptions of the intervention, the quitting process, and the factors that influence cessation. Thematic analysis was used to analyse the transcribed data. Themes were categorized into structural and individual factors, refined iteratively, and supported by illustrative quotes.

Four key facilitators were identified: (1) longer consultations enabling tailored support; (2) regular follow-up promoting patient engagement; (3) immediate and free access to NRT and carbon monoxide (CO) monitoring, reducing financial and practical barriers while providing feedback; and (4) shared decision-making, strengthening trust and improving the fit of support. These findings highlight the importance of addressing both treatment approach (contextual) and interpersonal factors for this population. Considering these elements may help adapt cessation programmes to the specific difficulties and needs of patients with low socioeconomic position, thereby reinforcing treatment adherence and improving effectiveness.

Patients’ involvement in the decision-making process is essential for shared decision-making and optimal patient-centered care. However, when there are concerns about a patient’s cognition and judgmen, the complexity of providing patient-centered care increases. It is often necessary to evaluate patients’ decision-making capacity (DMC) to determine whether they are able to make a particular decision or whether to rely on their previously expressed wishes or the patient’s caregivers.

In this article, we present a case of an older adult with colon cancer who presented to the emergency room.

We describe how multidisciplinary care can enhance the evaluation of DMC and improve quality of care for older patients with advanced cancer.

Multidisciplinary discussions and good communication skills are essential for navigating these complex situations, reducing potential harm and maximizimizing quality of life.

Advancements in healthcare have significantly improved the prospect of patients with CHD, with over 97% now surviving adulthood. This growing population requires lifelong care and support to manage their condition. Digital health innovations, such as the “Ask Me Anything” (AMA) tool, aim to empower patients and improve collaboration with clinicians.

In this pilot study, 70 patients were invited to participate, and 58 completed the questionnaire (response rate: 82.9%). Patients completed a digital question prompt list (QPL) prior to their consultations to select key topics from a predefined list of questions. Permission from the institution was obtained before conducting the pilot study.

Patients frequently selected questions related to prognosis, ageing, emotional well-being, lifestyle, and potential future interventions. The tool allowed for more personalised consultations and promoted active patient participation.

The AMA tool demonstrates feasibility in engaging ACHD patients and supporting shared decision-making. Further research is needed to optimise system integration and evaluate long-term outcomes.

Shared decision-making (SDM) is a collaborative process between clinicians and service users to select treatment, guided by evidence and service user preferences. SDM has clinical, economic, and ethical benefits compared to clinician-led decision-making; yet, implementation remains challenging. An important knowledge gap is the influence of culture on implementation. Cultural impacts on service user decision-making preferences have been documented, but little is known about how culture impacts clinician preferences. This study examined associations between country-level cultural characteristics and decision-making preferences of psychiatrists in routine care settings across Europe.

We analysed data from 751 psychiatrists and trainees in 38 European countries, who completed the Clinical Decision-Making Style–Staff (CDMS-S) scale. Country-level Hofstede cultural dimensions were linked to CDMS-S scores using univariate and multivariate regression models. Mixed-effects models were used to account for country-level clustering and controlling for professional and economic variables.

In univariate analyses, all six dimensions were associated with SDM preferences. However, only three remained significant in mixed-effects models. Higher levels of Indulgence and Individualism were associated with stronger preferences for SDM, while higher Power Distance was associated with more clinician-led decision-making. These associations did not remain significant in fully adjusted multivariate models, suggesting professional and systematic factors mediate cultural influences.

Indulgence, Individualism, and Power Distance are associated with psychiatrists’ decision-making preferences across Europe. Culturally sensitive SDM interventions should address not only clinician attitudes but also healthcare structures and patient expectations. Findings offer an empirical foundation for tailoring SDM training and policy to diverse cultural contexts within European psychiatry.

This systematic review aimed to analyze studies assessing the extent to which General Practitioners (GPs) engage patients in the decision-making process during consultations.

Shared Decision Making (SDM) stands at the core of patient-centred care, particularly in primary healthcare, where a diverse array of medical decisions transpires. In a 2015 systematic review summarizing studies on the Observing Patient Involvement in Decision Making (OPTION) instrument to assess SDM objectively across healthcare settings, a notable dearth of patient involvement was observed.

A comprehensive literature search encompassing three digital databases was conducted up to November 2023. Inclusion criteria focused on studies employing a comparative study design, centric to primary healthcare, and utilizing the OPTION-5 or -12 instrument to gauge SDM levels. Two investigators independently performed study selection, risk of bias assessment, and data extraction using a list of predefined variables, with discrepancies resolved by a third reviewer. PROSPERO registration-ID: CRD42023475419.

Initially, harvesting 447 articles, our review retained 29 studies published between 2003 and 2022. Mean age of GPs was 45.5 (range 33–53) years. Reported baseline OPTION scores varied between 1.5 and 57.2 on a 0–100-point scale, with a median score of 16. Following SDM interventions, OPTION-scores increased significantly to a median of 28.5, range 16–83.

The overall level of SDM among GPs remains relatively low and has shown minimal improvement over the past decade. However, interventions promoting SDM appear to enhance patient involvement levels. This underscores the necessity for increased education and tools, directed at GPs and patients, to foster and elevate the practice of SDM.