Shared decision making (SDM) is a collaborative process that aligns clinical expertise with patient values, goals, and preferences. In chronic gastrointestinal (GI) conditions, SDM helps patients navigate complex choices such as start, adjust, or stop medications, adopt lifestyle changes, or pursue surgical versus conservative options. The process begins with clinicians inviting patients to participate, presenting information in plain language, and checking understanding. It also involves acknowledging uncertainty and discussing potential outcomes, risks, and benefits of each option. When patients feel heard and informed, trust grows, enabling more durable engagement and adherence to agreed upon plans.
Implementing SDM in busy gastroenterology practices requires practical steps that fit into standard visits. Before appointments, clinicians can circulate decision aids and summarize common scenarios, so patients come prepared with questions. During visits, clinicians should explicitly state that patient preferences will shape decisions and invite patients to express concerns about side effects, burdens, or feasibility. Using teach-back methods to confirm understanding reduces miscommunication. Decisions are most effective when clinicians provide balanced information about alternatives, including no intervention, and invite questions about how options align with the patient’s daily life, family circumstances, and long-term goals.
Effective SDM demands preparation, clear communication, and collaborative follow-through.
A core component of SDM is presenting evidence in a balanced, accessible manner. Clinicians should translate research findings into practical implications—for example, how a medication’s efficacy translates into symptom relief, quality of life, and carryover effects. Side effects, monitoring requirements, costs, and accessibility must be explained clearly. Decision aids, whether printed, interactive, or digital, help patients compare options side by side. Importantly, clinicians should tailor information to the patient’s literacy level, cultural background, and language preferences. When patients understand the trade-offs, they are better equipped to articulate what matters most to them and participate in the final choice.
Celebrating patient autonomy does not undermine clinical guidance; it reinforces it. Clinicians remain experts who provide recommendations grounded in evidence, while patients contribute preferences that shape how those recommendations are applied. For instance, a patient might prioritize maintaining work responsibilities over minimal side effects, or value a nonpharmacologic approach to avoid medication risks. SDM acknowledges that “best” is context-dependent. The goal is a decision that both aligns with medical reasoning and resonates with the patient’s values, circumstances, and life plan. Achieving this balance requires deliberate communication, time, and mutual respect.
Clarifying values through questions, summaries, and collaborative planning.
Practical preparation for SDM includes identifying decision points commonly faced by GI patients, such as therapy initiation, dose adjustments, or surgery timing. Clinicians should assemble up-to-date, patient-friendly summaries of options, including benefits, harms, and uncertainties. They can also collect patient goals in advance—statements about symptom targets, activity levels, or risk tolerance—to guide the discussion. In the clinic, clinicians should set aside time specifically for decision making and minimize interruptions. Scheduling follow-up contacts, whether by phone, message, or brief visits, signals ongoing support and reinforces that the patient remains active partner in care.
Communication techniques that support SDM are essential. Clinicians should use open-ended questions to elicit patient concerns and preferences, reflect back what they hear to confirm understanding, and avoid medical jargon. Visual aids and plain-language summaries help patients grasp complex concepts quickly. Clinicians can pause to check comprehension, encourage questions, and acknowledge uncertainty as a natural part of treatment planning. Encouraging patients to involve family members or trusted friends in discussions can also improve understanding and ensure decisions align with personal support networks.
Team-based implementation, tools, and ongoing education sustain SDM.
The value of SDM grows when clinicians document decisions in the medical record with patient input explicitly noted. Documentation should capture the patient’s goals, preferred option, and the rationale for the chosen path. It should also record any contingencies, such as planned re-evaluation intervals or triggers for changing course. When appropriate, clinicians can enter a shared decision note or patient-facing summary into the portal, enabling ongoing review and revision. Clear documentation supports continuity of care across visits and providers, ensuring that care remains aligned with the patient’s stated values even as circumstances evolve.
Shared decision making also requires system-level supports. Multidisciplinary teams, including nurses, dietitians, pharmacists, and social workers, can reinforce SDM by providing consistent messaging. Decision aids should be available in multiple formats and languages, and staff should be trained to facilitate SDM conversations. Informational resources must be accurate and up-to-date, reflecting current guidelines and local practice realities. When systems back SDM with structure and education, patients experience coherence across care settings, which strengthens confidence and engagement in their treatment plan.
Engaging patients through accessible materials, culture, and ongoing evaluation.
Time constraints often challenge SDM, but efficiency can be built into practice design. Short, focused SDM conversations can occur within standard visits by prioritizing the most decision-sensitive topics first. Pre-visit questionnaires can surface patient preferences, and digital decision aids can be accessed asynchronously. Delegating parts of the SDM process to trained staff—such as presenting options and answering basic questions—frees clinicians to concentrate on complex deliberation. Regularly scheduled SDM training for clinicians and staff keeps communication skills sharp and ensures consistency across patient encounters.
Another important consideration is cultural humility. Clinicians should recognize diverse beliefs about medicine, pain, and the patient–doctor relationship. They must avoid assumptions and invite patients to explain how cultural values shape their choices. Adapting communication to respect those values improves trust and participation in SDM. Clinicians should also consider health literacy and numeracy, offering materials that explain risks in absolute terms, with practical examples. When patients see themselves reflected in information and guidance, they are more likely to engage meaningfully and cooperate with the chosen plan.
Ethical considerations underpin SDM, particularly around autonomy and informed consent. Practitioners must ensure that patients understand that participation is voluntary and that they can opt out of decisions at any time. The conversation should explore not only what patients want to do, but why they want it, what concerns they have, and how feasible it is within their daily life. Clear disclosures about uncertainties, alternative paths, and potential consequences help maintain trust. Regularly revisiting SDM in follow-up visits reinforces that patient preferences can evolve and should guide subsequent steps.
To sustain SDM in chronic GI care, measurement and feedback are valuable. Clinicians can monitor whether patients report understanding, satisfaction, and alignment with values after decisions. Patient-reported outcomes, decision process measures, and adherence indicators help identify gaps and opportunities for improvement. Continuous feedback loops—through surveys, focus groups, or patient ambassadors—inform iterative enhancements in decision aids and training. As practices invest in SDM, they cultivate a learning environment where patients become true partners, and treatment choices better reflect both scientific evidence and what matters most to those living with chronic GI conditions.
