Intended for healthcare professionals


Decision aids, empowerment, and shared decision making

BMJ 2014; 349 doi: (Published 25 September 2014) Cite this as: BMJ 2014;349:g5811
  1. Ian Hargraves, lead designer,
  2. Victor M Montori, professor of medicine
  1. 1Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA
  1. Correspondence to: V M Montori Montori.victor{at}

Each works or fails to work in patient-clinician conversations

Finding unexpected results when testing our ideas is the basis of learning, experimentation, and scientific method. In a linked paper (doi:10.1136/bmj.g5651), Denig and colleagues report on a randomized trial of a decision aid for patients with type 2 diabetes.1 After much well executed work in the development and testing of this decision aid, the authors concluded that it had a trivial, if any, effect on patient empowerment. What might we learn from this?

The trial tackles a real problem: the difficulties faced by patients and doctors in collaborating to target and control risk factors for adverse diabetes outcomes.2 Type 2 diabetes is both a medical disease—rarely the only chronic disease affecting patients—and a patient life issue. Targeting risk factors for diabetes requires commitment by both clinicians and patients, as it involves drug selection as well as the instigation of changes to patients’ lifestyles. This care can be overwhelming,3 and patients and clinicians should collaborate to prioritize the focus of treatment. Collaboration is, however, threatened by knowledge and power differences in …

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