Navigating the unknown: shared decision-making in the face of uncertainty.

In shared decision-making (SDM), patient and physician deliberate together on the basis of shared evidence, supporting the patient's choice among multiple options, informed by her values and preferences. One factor complicating the implementation of SDM is uncertainty, which has long been recognized in medicine but perhaps not sufficiently addressed in the context of SDM. In order to ensure that SDM can be realistically applied to real-world clinical encounters, the issue of uncertainty should be recognized and explicitly incorporated into SDM strategies. Here we propose practical approaches, based in doctor-patient communication science and bioethics, that may be of help for incorporating the uncertainty factor into SDM in the context of the doctor-patient encounter. We also discuss how decision aids might be more widely applicable through routinely acknowledging the preference sensitivity of decisions and supplementing these tools with a discussion of uncertainty.