The Shared Decision Making Gap

Randal Moseley, MD, FACP, FHM
Quality Medical Director, Confluence Health

When making health care decisions, patients are often faced with two extremes. One approach is simply asking patients to make care choices based on their own ideas of care. This assumes a patient understands their condition and has obtained good information about their choices. The other common option is to completely defer to the advice of the care provider. This assumes the care provider fully understands a patient’s values and lifestyle. Both of these traditional options have significant drawbacks. Somewhere between these two extremes lies the option of informed shared decision making. Care providers should routinely make evidence-based care information available to patients in a way that is engaging and easy to understand. Once this information is understood, a useful discussion of how care options play into a patient’s value system and lifestyle can take place. However in practice, achieving this middle road is very difficult. The biggest problem is that quality tools to help inform patients in this way are not commonly available. There has been some progress by a few institutions to fill this gap. But this gap remains alarmingly large for most common care decisions. It is the duty of the healthcare profession to fill this gap, and dedicating resources for this work should receive high priority in all healthcare systems. Find more information and resources on shared decision making at