Moving SDM forward in Canada: milestones, public involvement, and barriers that remain.

Canada's approach to shared decision making (SDM) is as disparate as its healthcare system; a conglomerate of 14 public plans at various administrative levels. SDM initiatives are taking place in different pockets of the country and are in different stages of development. The most advanced provincial initiative is occurring in Saskatchewan, where in 2010 the provincial government prepare to introduce patient decision aids into certain surgical specialties. With regard to decision support tools for patients, perhaps the most active entity is the Patient Decision Aids Research Group in Ottawa, Ontario. This group maintains a public inventory of decision aids ranked according to International Patient Decision Aid Standards and has developed the generic Ottawa Personal Decision Guide, as well as a toolkit for integrating decision aids in clinical practice. All of these tools are publicly available free of charge. Professional interest in SDM in Canada is not yet widespread, but Canada's principal health research funding agency is sponsoring several important SDM projects. Researchers from institutions across the country are promoting SDM through continuing professional development programs and other interventions in fields as varied as primary care, dietary medicine and workplace rehabilitation. Still, the future of SDM in Canada remains uncertain. Canada's provincially based structure obliges promoters to work with each province separately, and the recent growth of private healthcare risks dissipating efforts to implement SDM. 2011. Published by Elsevier GmbH.