I do not agree with the authors (1) that shared decision making (SDM) should primarily be used to improve patient-relevant, disease-related endpoints. According to international consensus, the aim of SDM is to reach “informed decisions”—that is, decisions based on complete information about all alternatives, including doing nothing, which reflect the subjective preferences of patients (2, 3).
The authors consider surrogate endpoints, the validity of which is either not, or not consistently given, as relevant for patients; this includes for instance HbA1c in type 2 diabetes mellitus, total cholesterol and LDL cholesterol after acute coronary syndrome, adherence of patients with bronchial asthma, or blood pressure in arterial hypertension. In particular, only increasing adherence or compliance cannot be, in my view, the purpose of SDM.
It is unclear why, of all terms, the MeSH term “shared decision making” was not considered in the literature search. Likewise, it is unclear why “decision aids” (or “patient decision support technologies”) were excluded (for instance, see [4]).
I completely agree with the authors, however, that the theoretical concept of SDM should be clarified, and that a consensus about the objectives (and objectives criteria) should be reached.
References
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