TY - JOUR T1 - Addressing disparities in patients’ opportunities for and competencies in shared decision making JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 75 LP - 78 DO - 10.1136/bmjqs-2021-013533 VL - 31 IS - 2 AU - Naomi Q P Tan AU - Robert J Volk Y1 - 2022/02/01 UR - http://qualitysafety.bmj.com/content/31/2/75.abstract N2 - In this issue of BMJ Quality & Safety, Birkeland and colleagues1 conducted an online experiment where 6756 male healthcare users in Denmark were randomised to view 1 of 30 case vignettes of possible scenarios they may encounter when making a decision about prostate cancer screening. In this study, 30 case vignettes were created that varied by level of patient involvement in making the decision, screening choice and downstream cancer outcomes.1 Despite using hypothetical scenarios and limiting the sample to men, this study yielded important insights into the impact of shared decision making (SDM) on peoples’ reports of satisfaction with their care.1 2 Birkeland and colleagues1 found that participants were generally more satisfied with scenarios where the doctor was in favour of PSA testing, but greatest levels of satisfaction with their healthcare were observed when there was SDM, use of a decision aid, and dialogue with their doctor. Interestingly, this remained the case even in scenarios where patients had poor outcomes, suggesting that ownership of the decision to screen is important in acceptance of poor clinical outcomes.1 These findings suggest that a high-quality SDM process, supported by the use of decision aids, may be protective against regret for patients who experience poor outcomes following a decision. More research with patients facing difficult, preference-sensitive healthcare decisions is needed to explore this hypothesis.Birkeland and colleague’s1 discussion highlights the prior mixed research regarding associations between SDM and patient satisfaction. Crucially, they suggest that one possible explanation for the mixed findings may have been the ceiling effects for patient satisfaction1; most patients tend to be satisfied with their care even if no SDM is involved. This finding aligns with previous research that found that while patients desired some level of involvement in decision making, they did … ER -