Shared Decision-Making in Chronic Care

Shared Decision-Making in Chronic Care. Foundations, Implementation and Recommendations
Xavier Bayona Huguet
June 2026

The increasing prevalence of chronic diseases, multimorbidity, and care complexity requires models of care that integrate scientific evidence with people’s needs, values, and preferences. In this context, shared decision-making (SDM) has become an essential component of person-centred care and value-based healthcare.

SDM is a collaborative process through which healthcare professionals and patients jointly deliberate on the different diagnostic or therapeutic options available. This model recognises the complementarity between the professional’s clinical knowledge and the patient’s lived experience, and promotes decisions tailored to individual circumstances. In this way, it moves beyond both the traditional paternalistic model and approaches that place the entire responsibility for decision-making on the patient.

Available evidence shows that SDM improves the care experience, increases satisfaction among both patients and professionals, promotes treatment adherence, and contributes to better health outcomes. It also enables more efficient use of healthcare resources by directing interventions towards the outcomes that genuinely matter to people.

SDM is particularly relevant in chronic conditions, where decisions are often complex, subject to revision over time, and closely related to quality of life. Multimorbidity, polypharmacy, clinical uncertainty, and the need to prioritise care goals make it essential to incorporate patients’ preferences into care planning. In many situations, it is also necessary to involve family members and caregivers.

SDM should be used particularly when there are several reasonable options, when the benefits and risks are not equivalent, even if they may appear so from the patient’s perspective, or when the choice depends on how each person values the possible outcomes. Its implementation can be supported by decision aids and structured models of clinical deliberation.

Digital transformation and artificial intelligence offer new opportunities to facilitate access to information, improve understanding of risks and benefits, and support clinical deliberation. However, they also raise challenges related to information quality, bias, and the digital divide, which require professional oversight.

To establish SDM as routine practice, organisational, educational, and cultural changes are needed. It should be incorporated into chronic care strategies, health literacy should be promoted, decision-support tools should be developed, and its impact should be systematically evaluated using indicators focused on patient experience and patient-reported outcomes.

SDM is currently the reference model for delivering care that is more humane, personalised, equitable, and value-based.