A three-talk model for shared decision making: multistage consultation process

Glyn Elwyn*, Marie Anne Durand, Julia Song, Johanna Aarts, Paul J. Barr, Zackary Berger, Nan Cochran, Dominick Frosch, Dariusz Galasinski, Pal Gulbrandsen, Paul K. J. Han, Martin Haerter, Paul Kinnersley, Amy Lloyd, Manish Mishra, Lilisbeth Perestelo-Perez, Isabelle Scholl, Kounosuke Tomori, Lyndal Trevena, Holly O. WittemanTrudy Van der Weijden

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

289 Citations (Web of Science)



To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement.


Multistage consultation process.


Key informant group, communities of interest, and survey of clinical specialties.


19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties.


After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals.


The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.

Original languageEnglish
Article numberj4891
Number of pages7
JournalBMJ (e)
Publication statusPublished - 6 Nov 2017



Cite this