The Connection Between Evidence-Based Medicine and Shared Decision Making

Evidence-based medicine (EBM) and shared decision making (SOM) are both essential to quality health care, yet the interdependence between these 2 approaches is not generally appreciated. EBM should begin and end with the patient: after finding and appraising the evidence and integrating its inferences with their expertise, clinicians attempt a decision that reflects their patient's values and circumstances. Incorporating patient values, preferences, and circumstances is probably the most difficult and poorly mapped step--yet it receives the least attention. This has led to a common criticism that EBM ignores patients' values and preferences--explicitly not its intention. SOM is the process of clinician and patient jointly participating in a health decision after discussing the options, the benefits and harms, and considering the patient's values, preferences, and circumstances. It is the intersection of patient-centered communication skills and EBM, in the pinnacle of good patient care. Here, Hoffman et al examine the connection between the EBM and SDM.