Shared decision making (SDM) is a clinical decision model that is highly recommended when more than one possible treatment option could fit an individual patient best. This is very often the case when making cancer treatment decisions, including decisions about radiotherapy. Choice between two or more medically reasonable options, e.g., undergoing or foregoing (neo-)adjuvant radiotherapy means uncertainty. Dealing with and resolving this uncertainty requires creating choice awareness in the patient and then, ideally, going through a decision process in which the patient is truly involved in order to combine the best scientific, medical, and clinical evidence, and what is important in this patient’s life. SDM is a means, in other words, to achieve evidence-based medicine as it was originally conceived. Extent to which patients are involved in treatment decisions depends on the perspective that is taken (perspective of the physician, patient, or an independent observer), and may depend on the exact definition that is used – many definitions exist, yet they share key elements. Regardless of perspective and definition, true patient involvement or shared decision making is still uncommon in clinical practice. This is also the case in radiotherapy treatment.
Various barriers have been identified for why shared decision making has not been widely implemented yet, and a fundamental barrier may relate to the vulnerable position in which patients find themselves with respect to clinicians, and to time. Interventions to promote the adoption of shared decision making among clinicians often include skills training and have shown to be feasible, well-received, and improve clinicians’ knowledge and skills. Interventions targeting patients more often include the provision of tools such as patient decision aids, which have repeatedly been shown to improve patients’ knowledge and decrease decisional conflict. Effective implementation of shared decision making is increasingly being considered as requiring a multifaceted approach, including a particular focus on individuals with lower health literacy skills. Overall, continuing efforts to substantiate, fine-tune, and promote shared decision making are required to ensure that decisions are made that align with what matters most to individual patients in order to offer person-centered care.