What is the next step in patient decision support?

Patient decision support systems have a promising role in the delivery of health care. However, the best approach for further development of these systems is a matter of speculation. To help chart a course for further development of decision support systems, we consider the four traditional roles that patients play in the medical decision making process, the limitations that patients face in participating in each role and describe how contemporary systems address can facilitate successful decision making for each role. Because patients have a diversity of preferences for the role they play in decision making, we believe that the critical research question is how to make decision support systems robust enough to support a patient's desired role, whatever that role might be. By directing research in decision support systems in this fashion, we believe that they will achieve a larger patient audience and have increased value in the delivery of clinical care.