Decision-making in the physician-patient encounter

In this paper we revisit and add elements to our earlier conceptualization of the meaning of shared treatment decision-making within the context of different approaches to decision-making in the medical encounter (Charles, Gafni and Whelan, 1997). This revised framework 1) explicitly identifies different analytic steps in the treatment decision-making process; 2) provides a dynamic view of treatment decision-making by recognixing that the approach adopted at the outset of a medical encounter may change as the interaction evolves; 3) identifies decision-making approaches which lie between the three predominant models (paternalistic, shared and informed); and 4) has practical applications for clinical practice, research and medical education. Rather than advocating a particular approach, we emphasize the importance of flexibility in the way that physicians structure the decision-making process so that individual differences in patient preferences can be respected.