Shared decision-making

Process in which a person and clinician review options, benefits, risks and individual preferences together.

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Understanding the approach

Shared decision-making is a way of choosing care together with a healthcare professional. It brings together scientific evidence, clinical experience and what matters to the person: activities, tolerance of risk, practical constraints and expectations. The clinician explains reasonable options, while the patient can ask questions and express preferences without being expected to have specialist knowledge.

Indications and assessment

A useful discussion identifies the problem being treated and the outcomes sought. It compares potential benefits, limitations, unwanted effects, cost and time commitment. Depending on the situation, monitoring symptoms or choosing not to add treatment may also be reasonable options. A medical emergency may limit the time available, but clear explanations still matter.

Benefits, limitations and precautions

NICE recommends accessible communication, discussion of uncertainty and appropriate decision aids. A percentage needs to identify the outcome being measured and the timeframe involved. When evidence is weak, this uncertainty should be stated. Consent to a procedure does not turn an uncertain possibility of benefit into a guaranteed outcome or remove the need for follow-up.

Place in the care pathway

For care discussed at TAGMED, the conversation should distinguish desired symptom relief from assumed anatomical correction. Motorised decompression, for example, is a form of traction with uncertain benefit depending on the indication. The plan can include reassessment and stopping criteria. Medication, injections or surgery require discussion with the relevant prescriber or specialist rather than being presented as TAGMED services.

Goals should be practical: walking farther, returning to a chosen activity or reducing symptoms that interfere with sleep. Improvement immediately after a session does not establish lasting benefit. Follow-up compares function with the starting point, records adverse effects and considers progress between appointments. An inadequate response should prompt a review of the clinical explanation or proposed approach, rather than an automatic extension of the same treatment.

Frequently asked questions

Must I decide alone?

No. You can ask for an explained recommendation and involve a trusted person in the conversation.

Can I decline an option?

Yes. Your preferences should be discussed alongside the possible consequences and relevant alternatives.

What questions help?

What benefits are realistic, what risks are involved and what might happen if we wait?

Can I change my mind?

Yes. Decisions can be reviewed when your priorities, symptoms or the available information change.

Does a decision aid replace an appointment?

No. It prepares or supports discussion and needs to match your clinical circumstances.

Educational information from The Spine Page. This entry does not replace an individual assessment. Documentary version: October 12, 2026. Sylvain Desforges, B.Sc., D.O., N.D., osteopath and naturopath.