Table 2.

Potential goals, measures of success, and challenges of policy-driven shared decision-making

Primary goal	Measures of Success	Challenges
Improved understanding or experience	Procedure comprehension Decision making process Patient engagement Patient satisfaction Decision conflict	Unclear how to value benefits and costs if decisions are not impacted Defining the scope: unclear how to identify procedures for which shared decision-making should be prioritized
Increasing alignment between patients’ values and choices	Values-choice concordance Impact on patients’ choices	The extent to which shared decision-making processes and tools such as DAs accomplish this goal is decision specific Longer term impacts are relevant but may be missed and are difficult to study
Reduce costs, utilization, improve healthcare outcomes	Healthcare expenditures Number of procedures Survival data or other healthrelated outcomes	Indirect connection between these outcomes and shared decision-making process Paradoxical effects are possible (e.g. reduction in implanted ICDs will likely drive an increase in mortality)