Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Shared decision-making in urology and female pelvic floor medicine and reconstructive surgery

Nature Reviews Urology volume 19, pages 161–170 (2022)Cite this article

Subjects

Abstract

Shared decision-making (SDM) is a hallmark of patient-centred care that uses informed consent to help guide patients with making complex health-care decisions. In SDM, patients and providers work together to determine the best course of action based on both the current available evidence and the patient’s values and preferences. SDM not only provides a framework for the legal and ethical obligations providers need to fulfil for informed consent, but also leads to improved knowledge of treatment options and satisfaction of decision-making for patients. Tools such as decision aids have been developed to support SDM for complex decisions. Several decision aids are available for use in the field of urology and female pelvic medicine and reconstructive surgery, but these decision aids are also associated with barriers to SDM implementation including patient, provider and systematic challenges. However, solutions to such barriers to SDM include continued development of SDM tools to improve patient engagement, expand training of providers in SDM communication models and a process to encourage implementation of SDM.

Key points

  • Shared decision-making (SDM) is a management approach in which providers and patients work together using the best available evidence to make decisions that fit with patients’ own values and preferences.

  • SDM improves patient knowledge of management options and satisfaction with decision-making.

  • SDM can help to satisfy the legal and ethical recommendations for patient counselling.

  • Decision aids are tools designed to help patients to make management decisions based on the information given by their care providers.

  • Barriers to SDM can arise owing to patient factors, provider training or system failings.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Patient care models.
Fig. 2: Quality dimensions for decision aids according to IPDAS.

Similar content being viewed by others

References

  1. Elwyn, G. et al. Implementing shared decision making in the NHS. BMJ 341, 971–972 (2010).

    Google Scholar 

  2. Kaplan, R. M., Ganiats, T. G. & Frosch, D. L. Diagnostic and treatment decisions in US Healthcare. J. Health Psychol. 9, 29–40 (2004).

    PubMed  Google Scholar 

  3. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century (National Academy Press, 2001).

  4. Chewning, B. et al. Patient preferences for shared decisions: a systematic review. Patient Educ. Couns. 86, 9–18 (2012).

    PubMed  Google Scholar 

  5. Aubree Shay, L. & Lafata, J. E. Where is the evidence? a systematic review of shared decision making and patient outcomes. Med. Decis. Mak. 35, 114–131 (2015).

    Google Scholar 

  6. McNair J. JUDGMENT Bolam (Appellant) v Friern Hospital Management Committee (Respondent) (England and Wales) 1 WLR 582 (1957).

  7. Lord, K., Lord, R. & Lord, H. JUDGMENT Montgomery (Appellant) v Lanarkshire Health Board (Respondent) (Scotland) Lady Hale, Deputy President (Courts of Justice, 2015).

  8. Chan, S. W., Tullock, E., Cooper, E. S., Smith, A. & Wojcik, W. Montgomery and informed consent: where are we now? BMJ 357, j2224 (2017).

    PubMed  Google Scholar 

  9. O’Connor, A. M. & Elwyn, G. IPDAS 2005: criteria for judging the quality of patient decision aids. In International Patient Decision Aids Standards (IPDAS) Collaboration 1–3 (IPDAS, 2005).

  10. Elwyn, G. et al. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS ONE 4, e4705 (2009).

    PubMed  PubMed Central  Google Scholar 

  11. National Institute for Health and Care Excellence. NICE Urinary Incontinence and Pelvic Organ Prolapse in Women: Management NICE guideline (NICE, 2019).

  12. Agency for Healthcare Research and Quality. The CAHPS Ambulatory Care Improvement Guide Practical Strategies for Improving Patient Experience Section 6: Strategies for Improving Patient Experience with Ambulatory Care 6.I. Shared Decision-Making (Agency for Healthcare Research and Quality, 2017).

  13. Stacey, D. et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst. Rev. 4, CD001431 (2017).

    PubMed  Google Scholar 

  14. Elwyn, G., Frosch, D., Volandes, A. E., Edwards, A. & Montori, V. M. Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions. Med. Decis. Mak. 30, 701–711 (2010).

    Google Scholar 

  15. Clifford, A. M., Ryan, J., Walsh, C. & Mccurtin, A. What information is used in treatment decision aids? A systematic review of the types of evidence populating health decision aids. BMC Med. Inf. Decis. Mak. 17, 22 (2017).

    Google Scholar 

  16. Street, R. L. Aiding medical decision making: a communication perspective. Med. Decis. Mak. 27, 550–553 (2007).

    Google Scholar 

  17. Vandvik, P. O. et al. Creating clinical practice guidelines we can trust, use, and share a new era is imminent. Chest 144, 381–389 (2013).

    PubMed  Google Scholar 

  18. Frosch, D. L., Légaré, F. & Mangione, C. M. Using decision aids in community-based primary care: a theory-driven evaluation with ethnically diverse patients. Patient Educ. Couns. 73, 490–496 (2008).

    PubMed  PubMed Central  Google Scholar 

  19. Agoritsas, T. et al. Decision aids that really promote shared decision making: the pace quickens. BMJ 350, g7624 (2015).

    PubMed  PubMed Central  Google Scholar 

  20. Walsh, T. et al. Undetermined impact of patient decision support interventions on healthcare costs and savings: systematic review. BMJ 348, g188 (2014).

    PubMed  PubMed Central  Google Scholar 

  21. Elwyn, G., Légaré, F., van der Weijden, T., Edwards, A. & May, C. Arduous implementation: does the Normalisation Process Model explain why it’s so difficult to embed decision support technologies for patients in routine clinical practice. Implement. Sci. 3, 57 (2008).

    PubMed  PubMed Central  Google Scholar 

  22. Elwyn, G. et al. Trustworthy guidelines — excellent; customized care tools even better. BMC Med. 13, 199 (2015).

    PubMed  PubMed Central  Google Scholar 

  23. Montori, V. M., Leblanc, A., Buchholz, A., Stilwell, D. L. & Tsapas, A. Basing information on comprehensive, critically appraised, and up-to-date syntheses of the scientific evidence: a quality dimension of the International Patient Decision Aid Standards. BMC Med. Inform. Decis. Mak. 13, S5 (2013).

    PubMed  PubMed Central  Google Scholar 

  24. Agoritsas, T., Dahm, P., Lyubov, L. & Tikkinen, K. Prostate-Specific Antigen (PSA) screening in men without symptoms of prostate cancer. MAGIC Evidence Ecosystem Foundation (2018).

  25. Elwyn, G. et al. Option Grid™ decision aid: prostate specific antigen (PSA) test: yes or no? Optiongrid https://www.optiongrid.org/option-grids/grid-landing/61/ (2021).

  26. Tikkinen, K. et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline. BMJ https://doi.org/10.1136/bmj.k3581 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rendon, R. A. et al. Canadian Urological Association recommendations on prostate cancer screening and early diagnosis. Can. Urol. Assoc. J. 11, 298–309 (2017).

    PubMed  PubMed Central  Google Scholar 

  28. Carter, H. B. et al. Early detection of prostate cancer: AUA guideline. J. Urol. 190, 419–426 (2013).

    PubMed  PubMed Central  Google Scholar 

  29. Mottet, N. et al. EAU Guidelines. Edn presented at the EAU Annual Congress Amsterdam (European Association of Urology, 2017).

  30. Bell, N. et al. Recommendations on screening for prostate cancer with the prostate-specific antigen test. CMAJ 186, 1225–1234 (2014).

    PubMed  PubMed Central  Google Scholar 

  31. Grossman, D. C. et al. Screening for prostate cancer: US Preventive Services Task Force Recommendation Statement. JAMA 319, 1901–1913 (2018).

    PubMed  Google Scholar 

  32. Vernooij, R. W. et al. Values and preferences of men for undergoing prostate-specific antigen screening for prostate cancer: a systematic review. BMJ Open 8, e025470 (2018).

    PubMed  PubMed Central  Google Scholar 

  33. Riikonen, J. M. et al. Decision aids for prostate cancer screening choice: a systematic review and meta-analysis. JAMA Intern. Med. 179, 1072–1082 (2019).

    PubMed  PubMed Central  Google Scholar 

  34. Hamdy, F. C. et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N. Engl. J. Med. 375, 1415–1424 (2016).

    PubMed  Google Scholar 

  35. Wolf, A. M. D. et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J. Clin. 60, 70–98 (2010).

    PubMed  Google Scholar 

  36. Feldman-Stewart, D. & Brundage, M. Prostate cancer decision aid for early-stage patients (The Ottawa Hospital Research Institute, 2015).

  37. Mangir, N. et al. Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP. Nat. Rev. Urol. 16, 675–689 (2019).

    PubMed  Google Scholar 

  38. Fatton, B. et al. Pelvic organ prolapse and sexual function. Nat. Rev. Urol. 17, 373–390 (2020).

    PubMed  Google Scholar 

  39. Uberoi, P. et al. Listening to women: a qualitative analysis of experiences after complications from mesh mid-urethral sling surgery. Urology 13, S00 (2020).

    Google Scholar 

  40. Agur, W. What matters to you when choosing surgery for stress urinary incontinence? NHS www.nhsaaa.net (2019).

  41. Öztürk, R. & Murt, A. Epidemiology of urological infections: a global burden. World J. Urol. 38, 2669–2679 (2020).

    PubMed  Google Scholar 

  42. Langford, B. J. et al. The benefits and harms of antibiotic prophylaxis for urinary tract infection in older adults. Clin. Infect. Dis. 2, 1–10 (2021).

    Google Scholar 

  43. National Institute for Health and Care Excellence. Decision aid: reducing the chance of recurrent urinary tract infection (UTI) in premenopausal women who are not pregnant. NICE https://www.nice.org.uk/guidance/ng112/resources/decision-aid-reducing-the-chance-of-recurrent-urinary-tract-infection-uti-in-premenopausal-women-who-are-not-pregnant-pdf-6600984157 (2018).

  44. Gill, I., Aron, M., Gervais, D. & Jewett, M. A. S. Small renal mass. N. Engl. J. Med. 362, 624–634 (2010).

    CAS  PubMed  Google Scholar 

  45. McAlpine, K. et al. Shared decision-making for the management of small renal masses — development and acceptability testing of a novel patient decision aid. Can. Urol. Assoc. J. 14, 385–391 (2020).

    PubMed  PubMed Central  Google Scholar 

  46. Russo, P., Szczech, L. A., Torres, G. S. & Swartz, M. D. Patient and caregiver knowledge and utilization of partial versus radical nephrectomy: results of a National Kidney Foundation survey to assess educational needs of kidney cancer patients and caregivers. Am. J. Kidney Dis. 61, 939–946 (2013).

    PubMed  Google Scholar 

  47. Jones, J. et al. The kidney cancer research priority-setting partnership: identifying the top 10 research priorities as defined by patients, caregivers, and expert clinicians. Can. Urol. Assoc. 11, 379–387 (2017).

    Google Scholar 

  48. Légaré, F., Phane Ratté, S., Gravel, K. & Graham, I. D. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ. Couns. 73, 526–535 (2008).

    PubMed  Google Scholar 

  49. Légaré, F. & Witteman, H. O. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff. 32, 276–284 (2013).

    Google Scholar 

  50. Elwyn, G. et al. ‘Many miles to go.’: a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med. Inf. Decis. Mak. 13, S14 (2013).

    Google Scholar 

  51. O’Connor, A. M. et al. Toward the ‘tipping point’: decision aids and informed patient choice. Health Aff. 26, 716–725 (2007).

    Google Scholar 

  52. Joseph-Williams, N. et al. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ 357, J1744 (2017).

    PubMed  PubMed Central  Google Scholar 

  53. Nielsen-Bohlman, L., Panzer, A., Hamlin, B. & Kindig, D. Institute of Medicine. Health Literacy: A Prescription to End Confusion. Committee on Health Literacy, Board on Neuroscience and Behavioral Health (National Academic Press, 2004).

  54. Joseph-Williams, N., Edward, A. & Elwyn, G. Power imbalance prevents shared decision making. BMJ 348, g3178 (2014).

    PubMed  Google Scholar 

  55. Frosch, D. L., May, S. G., Rendle, K. A. S., Tietbohl, C. & Elwyn, G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Aff. 31, 1030–1038 (2012).

    Google Scholar 

  56. Lloyd, A., Joseph-Williams, N., Edwards, A., Rix, A. & Elwyn, G. Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC). Implement. Sci. 8, 1–9 (2013).

    PubMed  PubMed Central  Google Scholar 

  57. Mccaffery, K. J., Smith, S. K. & Wolf, M. The challenge of shared decision making among patients with lower literacy: a frame-work for research and development. Med. Decis. Mak. 30, 35–44 (2010).

    Google Scholar 

  58. Nutbeam, D. & Kickbusch, I. Health promotion glossary. Health Promot. Int. 13, 349–364 (1998).

    Google Scholar 

  59. Haller, J., Keller, Z., Barr, S., Hadden, K. & Oliphant, S. Assessing readability: are urogynecologic patient education materials at an appropriate reading level? Female Pelvic Med. Reconstr. Surg. 25, 139–144 (2019).

    PubMed  Google Scholar 

  60. Colaco, M., Svider, P. F., Agarwal, N., Eloy, J. A. & Jackson, I. M. Readability assessment of online urology patient education materials. J. Urol. 189, 1048–1052 (2013).

    PubMed  Google Scholar 

  61. Betschart, P. et al. Readability assessment of online patient education materials provided by the European Association of Urology. Int. Urol. Nephrol. 49, 2111–2117 (2017).

    PubMed  Google Scholar 

  62. Pruthi, A. et al. Readability of American online patient education materials in urologic oncology: a need for simple communication. Urology 85, 351–356 (2015).

    PubMed  Google Scholar 

  63. Faggerlin, A., Zikmund-Fisher, B. & Ubel, P. Helping patients decide: ten steps to better risk communication. J. Natl Cancer Inst. 103, 1436–1443 (2011).

    Google Scholar 

  64. Mccaffery, K. J. et al. Addressing health literacy in patient decision aids. BMC Med. Inform. Decis. 13 (Suppl. 2), 1–14 (2012).

    Google Scholar 

  65. Katz, M. G., Jacobson, T. A. & Kripalani, S. Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis. J. Gen. Intern. Med. 22, 782–786 (2007).

    PubMed  PubMed Central  Google Scholar 

  66. Street, R., Voigt, B., Geyer, C. J., Manning, T. & Swanson, G. Increasing patient involvement in choosing treatment for early breast cancer. Cancer 76, 2275–2285 (1995).

    PubMed  Google Scholar 

  67. Menendez, M. E. et al. Patients with limited health literacy ask fewer questions during office visits with hand surgeons. Clin. Orthop. Relat. Res. 475, 1291–1297 (1999).

    Google Scholar 

  68. Mackenzie, C. Relational autonomy, normative authority and perfectionism. J. Soc. Philos. 39, 512–533 (2008).

    Google Scholar 

  69. Rapley, T. Distributed decision making: the anatomy of decisions-in-action. Sociol. Health Illn. 30, 429–444 (2008).

    PubMed  Google Scholar 

  70. Epstein, R. & Street, R. Shared mind: communication, decision making, and autonomy in serious illness. Ann. Fam. Med. 9, 454–461 (2011).

    PubMed  PubMed Central  Google Scholar 

  71. Casarett, D. The science of choosing wisely. N. Engl. J. Med. 374, 1203–1205 (2016).

    PubMed  Google Scholar 

  72. Gigerenzer, G., Mata, J. & Frank, R. Public knowledge of benefits of breast and prostate cancer screening in Europe. J. Natl Cancer Inst. 101, 1216–1220 (2009).

    PubMed  PubMed Central  Google Scholar 

  73. Hoffmann, T. & Del Mar, C. Patients’ expectations of the benefits and harms of treatments, screening, and tests a systematic review. JAMA Intern. Med. 175, 274–286 (2015).

    PubMed  Google Scholar 

  74. Hudson, B., Zarifeh, A., Young, L. & Wells, J. Patient’s expectations of screening and preventive treatments. Ann. Fam. Med. 10, 495–502 (2012).

    PubMed  PubMed Central  Google Scholar 

  75. Lin, G. A. & Redberg, R. F. Addressing overuse of medical services one decision at a time. JAMA Intern. Med. 175, 1092–1093 (2015).

    PubMed  Google Scholar 

  76. Scholl, I., LaRussa, A., Hahlweg, P., Kobrin, S. & Elwyn, G. Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them — a scoping review. Implement. Sci. 13, 1–22 (2018).

    Google Scholar 

  77. Drost, L. E. et al. SHAred DEcision making in Pelvic Organ Prolapse (SHADE-POP); implementation is not as easy as it seems. Patient Educ. Couns. 104, 2004–2011 (2021).

    CAS  PubMed  Google Scholar 

  78. Lane, G. I. et al. Shared decision-making in urologic practice: results from the 2019 AUA Census. Urology 145, 66–72 (2020).

    PubMed  Google Scholar 

  79. Institute of Medicine. Assessing and Improving Value in Cancer Care: Workshop Summary (The National Academies Press, 2009).

  80. Mjåset, C., Nagra, N. S. & Feeley, T. W. Value-based health care in four different health care systems. NEJM Catal. https://doi.org/10.1056/CAT.20.0530 (2020).

    Article  Google Scholar 

  81. Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. & Wharton, G. International Health Care System Profiles Netherlands. The Commonwealth Fund https://www.commonwealthfund.org/international-health-policy-center/countries/netherlands (2020).

  82. Van Leersum, N. et al. Cure for increasing health care costs: the Bernhoven case as driver of new standards of appropriate care. Health Policy 123, 306–311 (2019).

    PubMed  Google Scholar 

  83. Stalnikowicz, R. & Brezis, M. Meaningful shared decision-making: complex process demanding cognitive and emotional skills. J. Eval. Clin. Pract. 26, 431–438 (2020).

    PubMed  Google Scholar 

  84. Mack, J. W. & Smith, T. J. Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. J. Clin. Oncol. 30, 2715–2117 (2012).

    PubMed  Google Scholar 

  85. Pollard, S., Bansback, N. & Bryan, S. Physician attitudes toward shared decision making: a systematic review. Patient Educ. Couns. 98, 1046–1057 (2015).

    PubMed  Google Scholar 

  86. Légaré, F. et al. Patientsʼ perceptions of sharing in decisions. Patient 5, 1–19 (2012).

    PubMed  Google Scholar 

  87. Agency for Healthcare Research and Quality. The SHARE approach — essential steps of shared decision making: expanded reference guide with sample conversation starters. AHRQ https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tool/resource-2.html (2020).

  88. Berkhof, M., Jolanda Van Rijssen, H., Schellart, A. J. M., Anema, J. R. & Van Der Beek, A. J. Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Educ. Couns. 84, 152–162 (2011).

    PubMed  Google Scholar 

  89. Marshall, S. Pelvic Organ Prolapse: Should I have Surgery (Ottawa Hospital Research Institute, 2020).

  90. Osborne, R., Batterham, R., Elsworth, G., Hawkins, M. & Buchbinder, R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public. Health 13, 658 (2013).

    PubMed  PubMed Central  Google Scholar 

  91. Arozullah, A., Yarnold, P. & Bennett, C. Development and validation of a short-form, rapid estimate of adult literacy in medicine. Med. Care 45, 1026–1033 (2007).

    PubMed  Google Scholar 

  92. Parker, R. M., Baker, D. W., Willia, M. V. & Nurss, J. R. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J. Gen. Intern. Med. 10, 537–541 (1995).

    CAS  PubMed  Google Scholar 

  93. Lee, S., Stucky, B., Lee, J., Rozier, R. & Bender, D. Short Assessment of Health Literacy-Spanish and English: a comparable test of health literacy for Spanish and English speakers. Health Serv. Res. 45, 1105–1120 (2010).

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urogynecology, Department of Urology, University of Texas Health San Antonio, Joe R & Theresa Long School of Medicine, San Antonio, TX, USA

    David A. Ossin & Sylvia M. Botros

  2. Department of Obstetrics and Gynaecology, Stoke Mandeville Hospital, Aylesbury, UK

    Emily C. Carter

  3. Department of Urogynaecology, LNWH NHS Trust, London, UK & Department of Epidemiology & Biostatistics, Imperial College London, London, UK

    Rufus Cartwright

  4. Department of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada

    Philippe D. Violette

  5. Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, The University of Chicago, Chicago, IL, USA

    Shilpa Iyer

  6. Department of Urology Eisenhower Medical Associates, Rancho Mirage, CA, USA

    Geraldine T. Klein

  7. Department of Obstetrics and Gynecology, Northshore University HealthSystem, Evanston, IL, USA

    Sangeeta Senapati

  8. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Sangeeta Senapati

  9. Division of Urology, Department of Surgery, Augusta University-Medical College of Georgia, Augusta, GA, USA

    Zachary Klaassen

Authors
  1. David A. Ossin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily C. Carter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rufus Cartwright
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philippe D. Violette
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shilpa Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Geraldine T. Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sangeeta Senapati
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zachary Klaassen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sylvia M. Botros
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors researched data for the article and wrote the manuscript. D.A.O., E.C.C., R.C., P.D.V., S.I., G.T.K., S.S. and S.M.B. contributed substantially to discussion of the manuscript and reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to David A. Ossin.

Ethics declarations

Competing interests

S.S. is a consultant for Emmi Solutions and AbbVie, and also has an ownership interest in KLAAS LLC. The other authors declare no competing interests.

Additional information

Peer review information

Nature Reviews Urology thanks Genevieve Nadeau and the other, anonymous, reviewers for their contribution to the peer review of this work.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Related links

MAGIC Evidence Ecosystem Foundation: https://magicevidence.org/

National Institute for Health and Care Excellence: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making

OptionGrid: http://www.optiongrid.org/

Ottawa Hospital Research Institute: https://decisionaid.ohri.ca/AZlist.html

The International Patient Decision Aid Standards (IPDAS) Collaboration: http://ipdas.ohri.ca/

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ossin, D.A., Carter, E.C., Cartwright, R. et al. Shared decision-making in urology and female pelvic floor medicine and reconstructive surgery. Nat Rev Urol 19, 161–170 (2022). https://doi.org/10.1038/s41585-021-00551-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41585-021-00551-4

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing