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Health Expect. 2009 Jun;12(2):160-74. doi: 10.1111/j.1369-7625.2008.00525.x. Epub 2009 Feb 22.

Mutual influence in shared decision making: a collaborative study of patients and physicians.

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Department of Medicine, Harvard Medical School, Mount Auburn Hospital, Cambridge, MA 02138, USA.

Erratum in

  • Health Expect. 2009 Sep;12(3):343.



To explore how patients and physicians describe attitudes and behaviours that facilitate shared decision making. Background Studies have described physician behaviours in shared decision making, explored decision aids for informing patients and queried whether patients and physicians want to share decisions. Little attention has been paid to patients' behaviors that facilitate shared decision making or to the influence of patients and physicians on each other during this process.


Qualitative analysis of data from four research work groups, each composed of patients with chronic conditions and primary care physicians.


Eighty-five patients and physicians identified six categories of paired physician/patient themes, including act in a relational way; explore/express patient's feelings and preferences; discuss information and options; seek information, support and advice; share control and negotiate a decision; and patients act on their own behalf and physicians act on behalf of the patient. Similar attitudes and behaviours were described for both patients and physicians. Participants described a dynamic process in which patients and physicians influence each other throughout shared decision making.


This study is unique in that clinicians and patients collaboratively defined and described attitudes and behaviours that facilitate shared decision making and expand previous descriptions, particularly of patient attitudes and behaviours that facilitate shared decision making. Study participants described relational, contextual and affective behaviours and attitudes for both patients and physicians, and explicitly discussed sharing control and negotiation. The complementary, interactive behaviours described in the themes for both patients and physicians illustrate mutual influence of patients and physicians on each other.

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