Generalized shared decision making approaches and patient problems. Adapting AHRQ's SHARE Approach for Purposeful SDM

Objective: Generalized shared decision making (SDM) describes the involvement of patients in choosing options. However, there are many situations in which patients and clinicians make decisions together that don't focus on choosing between options, e.g. problem-solving dialysis and insulin use while traveling. Poor uptake associated with clinicians’ perception that SDM doesn't apply to clinical situations they face may reflect the lack of adaptation of generalized SDM approaches to patients’ problems. The Purposeful SDM schema published in 2019 identifies problems for which different kinds of SDM are appropriate. Methods: The U.S. Agency for Healthcare Research and Quality developed SHARE as a generalized SDM approach. We sought to adapt SHARE to the different problems that patients face using a matrix to relate SHARE steps and Purposeful SDM modes and describe changes in generalized concepts and practices of SDM across these modes. Results: Many SHARE communicative behaviors applied across modes, although the meaning of SDM terms and practices, e.g. patients involved as problem solvers versus experts, varied substantially. Conclusion: Aspects of SHARE require adaptation to different patient problems. Practice implications: SDM in education, practice, and tools may be supported by adapting generalized SDM approaches to patients’ problems.