Table 1.

Key features and implications of narrow and broader understandings of shared decision-making

Narrow understandings of shared decision-making	Broader understandings of shared decision-making
Reflect and are congruent with notion of respect for autonomous choices.	Reflect and are congruent with notion of support for a person's autonomy (understood relationally).
Scope of concern of shared decision-making is primarily task-oriented communication for decision-making.	Scope of concern of shared decision-making includes communication relating to decision-making, but also emphasizes the relationship in which communication is embedded, and the motivations and experiences of both clinician and patient participants.
Emphasizes protection of patients from inappropriate paternalism and relies on a division of labour to achieve this: –Clinician brings research-based information about options and outcomes –Patient ‘independently’ brings or forms their individual preferences	Emphasizes enablement of patients' participation and requires clinicians to interact responsively and flexibly to support this. Provision of research-based information and attention to individual patients' needs, values and preferences are important, but attention is also paid to clinicians' attitudes towards patients and softer communication and relationship building skills. Division of labour is less strict. Dialogue is more open ended.
Patients' sharing in decision-making is understood primarily in terms of their role in selecting a healthcare option from a menu of at least two options.	Patients' sharing in decision-making is understood in multiple senses. Their perceptions of involvement and inclination to ‘own’ decisions are recognized aspects of sharing, as well as their contributions to option selection and other stages of healthcare decision-making.
Clinician respects (stands back and abides by) patient's preferences/choices.	Clinician respects (affirms and supports) patient as person in broader sense. This involves taking patient's expressed preferences seriously, but not necessarily abiding by them without discussion. Support for autonomy-capability becomes salient.
Any challenging of patients' preferences is restricted to checking patient's factual understanding and reiterating or providing more information.	Respectful treatment of the patient may involve challenging patient's expressed preferences or choices to check their congruence with personal values and life plans. It may even involve contributing to the formation or revision of preferences - as a friend or mentor might when supporting decision-making.
Require patients to (1) understand information about options and outcomes and (2) ‘independently’ formulate and express preferences about these.	Are less demanding on patients' information processing and decision-making skills. Accept that a person's preference formation and expression may be achieved in collaboration.
Can sometimes protect some patients from inappropriately paternalistic clinical influence BUT may not facilitateindividually appropriate forms of involvement AND may not allow sufficient clinical support to enable all patients to participate appropriately.	Enable more patients to share in decisions in a variety of senses by virtue of a fuller range of forms of decision support AND facilitate individually appropriate forms of involvement BUT in practice require high levels of clinician skill and virtue if they are not to degenerate to inappropriate paternalism.
Can be assessed by observing communication in consultations.	Require attention to context and subjective perspectives of clinicians and patients, as well as communication between them.