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BMJ. 2017 Nov 6;359:j4891. doi: 10.1136/bmj.j4891.

A three-talk model for shared decision making: multistage consultation process.

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The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA.
Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands.
Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA.
Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
Faculty of Arts, University of Wolverhampton, Wolverhampton, UK.
Institute of Clinical Medicine, University of Oslo, HØKH Research Centre, Akershus University Hospital Sykehusveien 25, Lørenskog, Norway.
Center for Outcomes Research & Evaluation, Maine Medical Center, Portland, Maine, USA.
University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany.
Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK.
Evaluation Unit, Canary Islands Health Service, Camino Candelaria, El Rosario, Tenerife, Spain.
Department of Occupational therapy, Tokyo University of Technology, Nishikamata, Ohtaku, Tokyo, Japan.
Discipline of General Practice, Sydney School of Public Health, University of Sydney, NSW, Australia.
Department of Family and Emergency Medicine, Université Laval, Quebec, Canada.
Department of Family Medicine, School CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands.


Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement.Design Multistage consultation process.Setting Key informant group, communities of interest, and survey of clinical specialties.Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties.Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals.Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.

[Indexed for MEDLINE]
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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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