Shared decision-making in depression: From a generalized ethical imperative to a personalized approach? A narrative review.

backgroundWhile both evidence-based medicine as well as personalized patient-centered medicine are glorified, clinical practice seems to be only partially influenced by guidelines or by patients' views. Against this background, shared decision-making (SDM) became a hype but remains an ill-defined concept: it can be considered as an umbrella concept covering therapeutic alliance, physician and patient preferences, information giving, information retrieving, information receiving, patient involvement in goal setting, decision-making, and treatment choice.

methodsA narrative review based on a literature search in PubMed and PsycINFO.

resultsSDM in depression should move away from an ethical imperative where "one size fits all" toward a personalized approach, tailoring the medical encounter to the physician's and patient's expectations (knowledge, need for knowledge, and desire for degree of SDM) and to the patient's clinical status. SDM cannot be conceived as a "snapshot" since it is a dynamic process where adjustments should be made depending on the growth of the doctor-patient alliance, the changes in expectations, and the changes in clinical status. The clinician should be more aware of barriers to effective implementation of SDM in him or herself, in the patient. The different definitions of SDM and the many reported SDM interventions (having different ingredients) hamper final conclusions on the effect of SDM on outcomes.

conclusionsThis narrative review aims to critically examine SDM in depression and proposes to conceptualize it as a dynamic, relational, and personalized process rather than a universal ethical standard.