Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Background – Decision Support

Patient participation in health care decision making is often called shared decision making. Patients who have been involved in decisions about their health and health care may experience:

  • increased satisfaction with their decision
  • increased quality of life
  • higher levels of psychological functioning
  • increased sense of well-being
  • delayed disease progression, and decreased morbidity and mortality
  • decreased levels of anxiety and depression
  • increased feelings of control over their illness
  • increased self-efficacy

(King, 1998, 2000; Marron et al., 2005)

Decisional conflict occurs when patients feel unable to make quality decisions regarding their care (Lin, Lee & Hicks, 2005). A patient’s ability to make these decisions may be hampered by:

  • not having enough information
  • being uncertain about what to expect
  • being unclear about what is most important
  • feeling pressured or unsupported
  • impaired cognition related to physiological disease processes and/or emotional stress

Other factors that may affect a patient’s ability to make a choice include:

  • interruptions in self-identity and self-concepts
  • fear of suffering
  • fear of loss of lifestyle
  • fear of death
  • fear of becoming a burden
  • worry over perceived physical limitations (Andrew, 2001)

Decision support provides a means to understanding what may be contributing to the patient’s decisional conflict. Decision support can then be tailored to address sources of patient’s decisional conflict. Involving patients in shared decision making can help to ensure that patients get the care that meets their needs and that best fits their preferences, energy and situation.