Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting

Background: In shared decision making, health care professionals and patients collaborate in making health-related choices. This process is based on autonomy and constitutes one to the elements of patient-centered care. However, there are situations where shared decision making is more difficult, if not impossible, due to barriers, which may be related to language, culture, education, or mental capacity and external factors like the state of emergency or the availability of alternative sources of information. Aim: The aim of this paper is to identify some of the main obstacles to the adoption of shared decision making in an intensive and critical care scenario and discuss potential ways to facilitate its implementation. Methods: We conducted a literature review on shared decision making from the perspective of intensive and critical care specialists. Discussion: Although the health care context is complex and the variety of situation that can arise makes it impossible to prepare professionals for every occurrence, shared decision making process should be structured at an organization level, engaging health care professionals, experts of communication, and patient representatives coming from different cultural backgrounds, languages, and education to assemble for all the main procedures, where shared decision making is involved, the specific information packages health care professionals will use in order to guide them through the process and ensuring all patients receive a comparable level of engagement. Shared decision making should not become a hindrance for the health care professional but on the contrary a way to strengthen their relationship with the patient. Conclusion: The implementation of the shared decision making approach at an organization-wide level improves its quality and effectiveness.