Shared decision-making in Israel: status, barriers, and recommendations

Shared decision making (SDM), "the attempt to involve patients in decision-making tasks, especially where decisions, in the face of uncertain or equivocal evidence of benefit, are sensitive to personal preferences" [1], has grown in prevalence worldwide over the last two decades [2]. SDM relates to involving patients in various issues, including screening, treatment options, administration of medication, nutrition, and lifestyle interventions. SDM has influenced the way medicine is practiced and has sparked interest in exploring ways to involve patients in their healthcare decisions and measure the effects of this involvement [3].Indeed most patients wish to take an active part in choosing among alternative courses of action regarding their health, with the physician either participating in the decision or providing relevant information and then allowing the patient to decide autonomously [4]. Beyond the higher ethical standards associated with greater patient involvement as compared with physician paternalism, SDM has practical merits. An impressive corpus of research has shown that patient involvement leads to better knowledge about treatment options, more realistic expectations concerning disease course and treatment, improved adherence, enhanced patient satisfaction, and sometimes a better clinical outcome [5].Though ultimately manifest at the level of the patient-physician encounter, SDM must first be legally mandated and medical professionals must be trained to incorporate its principles into their practice. Further, research studies are necessary to monitor its status and drive improvement. Moreover, these activities must be supported and promoted by national health, legal, and other organizations. Some countries have allocated resources for the promotion and evaluation of SDM. In Germany, the ministry of health funded the research consortium ''Patient as partner in medical decision-making'' [6]. In Canada, the importance of SDM is reflected in increased fund