PERSPECTIVES BJD British Journal of Dermatology Shared decision making and patient decision aids in dermatology J. Tan, 1 E. Linos, 2 M.A. Sendelweck, 3 E.J. van Zuuren, 4 S. Ersser, 5 R.P. Dellavalle 6 and H. Williams 7 1 Western University, London, ON, Canada 2 Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, U.S.A. 3 University of Colorado, Aurora, CO, U.S.A. 4 Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands 5 School of Healthcare, University of Leeds, Leeds, U.K. 6 Denver Veterans Affairs Medical Center, Denver, CO, U.S.A. 7 Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K. Correspondence Jerry Tan. E-mail: jerrytan@bellnet.ca Accepted for publication 10 May 2016 Funding sources None. Conflicts of interest J.T. holds the copyright for ‘What can you do to manage your psoriasis? A decision aid for plaque psoriasis patients’. 9 DOI 10.1111/bjd.14803 Summary Shared decision making combines individual patient interests and values with clinical best evidence under the guiding principle of patient autonomy. Patient decision aids can support shared decision making and facilitate decisions that have multiple options with varying outcomes for which patients may attribute different values. Given the variable psychosocial impact of skin disease on indivi- duals and relative uncertainty regarding best treatments and their adherence in many dermatological conditions, informed shared decision making, supported by patient decision aids, should constitute a central component of dermatological care. Patients are experts in their illness – they directly experience symptoms and psychosocial impact within the context of their personal circumstances. Healthcare providers are experts in management of disease and have access to medical informa- tion and evidence. Shared decision making (SDM) reflects the importance of these two complementary expert groups, with a convergence of patient interests and values combined with clinical expertise and the best evidence around the central ethic of patient autonomy. 1 Medical innovation develops along a pathway of identifying clinical need, biomedical research and discovery, critical appraisal and synthesis, development of clinical practice guide- lines and implementation into practice. 2 While clinical practice guidelines arose from the evidence-based medicine movement and integrate best evidence, they are developed for care provi- ders, not to assist patients with decision making. Closing this loop of innovation to a patient requires exploration of an indi- vidual’s values and preferences. Several studies have found that a substantial percentage of patients would like to play a more active role in their healthcare decisions. 3 Patient decision aids (pDAs) are tools to engage patients in this decision making. They are particularly suited for complex decisions that have multiple options with varying outcomes, for which patients may attribute different values. Furthermore, in clinical situations in which outcome information is limited or uncertain, the best choice depends on the importance that the patient places on each of the benefits, harms and scientific uncertainties. 4 In dermatology, the quality of medical evidence has improved substantially, but little has been done to incor- porate SDM. Herein we discuss SDM in dermatology, the effectiveness of pDAs, and their potential role in dermatology. Dermatology is a specialty particularly suited to SDM, as the severity of most dermatological diseases is defined by patients’ experience of symptoms and adverse psychosocial impact. Patients vary greatly in how they respond to dermatological diseases, as clinical determinants of severity often do not pre- dict psychosocial impact. For example, some with severe acne may be unperturbed while others with few lesions may be highly distraught. Treatment decisions in dermatology are therefore particularly guided by personal characteristics, cir- cumstances and preferences – beyond objective disease sever- ity. Such decisions are especially important to share with patients who have a responsibility to self-manage chronic ill- ness. Accordingly, the majority of treatment decisions in © 2016 British Association of Dermatologists British Journal of Dermatology (2016) 175, pp1045–1048 1045