Shared decision-making in Canada: update, challenges and where next!

There is considerable interest for shared decision-making (SDM) within the Canadian healthcare system. The current state of SDM in Canada and challenges with implementation are addressed in the paper at three levels of patient involvement: (1) healthcare system (macro-level); (2) institutions (meso-level) and (3) clinical/medical encounter (micro-level). The legal obligation for doctors to fully disclose information enabling patients' participation in decisions has spawned professional codes and guidelines with a vision of patient's empowerment through the use of patient decision aid and SDM. Nevertheless, a survey of general practitioners in 2002 indicated that they perceived their role as relieving anxiety induced in patients rather than engaging them in informed decision-making. The virtue of SDM has gained recognition through increased research funding, medical training and some initiatives embedding patient decision aids within the process of care. Future perspectives of SDM in Canada are highlighted such as evaluation of the long-term impact of and costs associated with patient participation in decisions as well as interprofessional approaches to SDM.