Assignment: Conceptualized SDM
the best available research evidence. If SDM does not in- corporate this body of evidence, the preferences that pa- tients express may not be based on reliable estimates of the risks and benefits of the options, and the result- ing decisions not truly informed.
Why Is There a Disconnect? A contributor to the existing disconnect between EBM and SDM may be that leaders, researchers, and teach- ers of EBM, and those of SDM, originated from, and his- torically tended to practice, research, publish, and col- laborate, in different clusters. Some forms of SDM have emerged from patient communication, with much of its research presented in conferences and journals in this field. A seminal paper in 19974 conceptualized SDM as a model of treatment decision making and as a patient- clinician communication skill. However, it did so with- out any connection to EBM—perhaps not surprisingly, be- cause EBM was in its infancy.2
Conversely, with its origins in clinical epidemiology, much of the focus of EBM has been on methods and resources to facilitate locating, appraising, and synthe- sizing evidence. There has been much less focus on dis- cussing this evidence with patients and engaging with them in its use (sometimes even disparagingly referred to as “soft” skills). Most of the EBM attention has involved scandals (eg, unpublished data, results “spin,” conflicts of interest) and the high technology mile- stones (eg, systems to make EBM better and easier). Information about using evidence in decision-making with patients has been scant.
Disconnect between the 2 ap- proaches is also evident in, and main- tained by, the teaching provided to clinicians and students, again often reflecting the backgrounds of their teachers. Opportunities to attend EBM teaching abound with content largely
focused on forming questions and finding and criti- cally appraising evidence.5 Learning how to apply and integrate the evidence is usually absent, or mentioned in passing without skill training.
Realizing the Connection Between EBM and SDM A logical place to start is by incorporating SDM skill train- ing into EBM training. This will help to address not only the aforementioned deficits in EBM training but also the lack of SDM training opportunities presently available. Additionally, it may facilitate the uptake of SDM and, more broadly, evidence translation. Recent calls for SDM to be routinely incorporated into medical education pre- sent an immediate opportunity to capitalize on closely aligning the approaches.
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