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Can shared decision making increase the uptake of evidence in clinical practice?
  1. France Légaré1,2,
  2. Michèle Shemilt1,
  3. Dawn Stacey3
  1. 1Research Centre of the Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada
  2. 2Department of Family and Emergency Medicine, Université Laval, Québec City, Québec, Canada
  3. 3School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr F Légaré, St François D’Assise Hospital, 10 rue Espinay, Québec City, QC G1L 3L5, Canada; france.legare{at}


Despite copious research and clear policies in many healthcare systems, evidence based practice has yet to be widely adopted. Part of the problem is insufficient consideration of the patient–clinician consultation, which lies at the heart of clinical practice and is where most decisions are made. Shared decision making (SDM)—the interactive process in which patients and clinicians decide on healthcare together—capitalises on the consultation to better translate the best evidence into clinical decisions while taking the patient's values and preferences into account. This paper takes stock of interventions that seek to embed SDM in clinical practice, such as patient decision aids that target both patients and clinicians. It also presents challenges that remain: among others, the paucity of evidence on effective implementation strategies and the lack of consideration of how SDM works when care is delivered by interprofessional teams. The paper then reviews current initiatives to improve and disseminate SDM across the healthcare continuum, and discusses why SDM should be encouraged as a means to leverage evidence based practice. The evidence suggests that finding ways to overcome the challenges and promote SDM will accelerate the uptake of evidence in gastroenterology and hepatology clinical practice.

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  • Competing interests FL holds a Tier 2 Canada Research Chair in Implementation of Shared Decision Making in Primary Care.

  • Provenance and peer review Commissioned; externally peer reviewed.