REHB1001 Chap.6 Shared Decision Making and the Four Habits
Shared Decision Making and the Four Habits
Topic 8 defines shared decision making as a collaboration in which the therapist's analysis, evidence about options and uncertainties, and the person's preferences come together in a choice about care.
This chapter explains why it matters, how it is often reduced to agreement or consent, and how the Four Habits model structures a consultation: investing in the beginning, eliciting the person's perspective, demonstrating empathy and investing in the end. It finishes with open questions, teach-back and the idea of a decision continuum.
The worked example rewrites a one-way end-of-session plan into a shared decision, and practice items cover open questions and checking understanding.
What this chapter covers
- 01
Definition of shared decision making
- 02
Why it is an ethical imperative
- 03
What is often left out
- 04
The Four Habits model
- 05
Rewriting a one-way explanation
- 06
Open questions and teach-back
- 07
The SDM continuum
Worked example · free
Turning a closed question into an open one
- +1The question is closed and invites only yes or no.
- +1It assumes work is the main concern and may lead the answer.
- +1A better version is open: 'How is your back affecting the things you need or want to do each week?'
- +1The answer reveals the person's own priorities, which the options and goals can then be built around.
Key terms
- Shared decision making
- A collaboration in which analysis, evidence and the person's preferences combine in a choice about care.
- Four Habits model
- A consultation structure of beginning, eliciting perspective, empathy and ending well.
- Teach-back
- Asking the person to explain the plan in their own words to check understanding.
- Decision support aid
- An evidence-based tool designed to help a patient form a management preference.
- Interactive reasoning
- Reasoning that builds and maintains rapport and the therapeutic alliance.
Shared Decision Making and the Four Habits FAQ
Is informed consent the same as shared decision making?
No. Topic 8 warns that SDM is often reduced to agreeing a plan already chosen or to consent for a procedure. Genuine shared decisions explain the analysis, set out the real options, including natural recovery and self-management, give the size of benefits and harms, and invite the person's preference.
What does demonstrating empathy add to a consultation?
The script links empathy with a stronger therapeutic alliance, better coping, greater trust, more satisfaction and even reduced symptoms. It means noticing negative emotion when it appears and responding to it, which is why the habit runs through the whole session rather than sitting at one point.
What if a patient just wants to be told what to do?
That preference is respected. Topic 8 describes shared decision making as a continuum and says autonomy includes the right to give up some of it and be directed. You still explain the analysis and options, then follow the person's wish about how much to decide themselves.
What are the Four Habits?
Topic 8 adapts the model from Frankel and Stein: invest in the beginning by building rapport and setting the scene; elicit the person's perspective, including the impact of the problem and their beliefs; demonstrate empathy when negative emotion appears; and invest in the end by explaining, discussing options and agreeing actions.
When does shared decision making matter most?
The introduction says it is most important when no option is clearly better than another, when the person's preferences are strong, or when there is a risk of harm. In those situations the patient's knowledge of their own life and values carries as much weight as the therapist's knowledge of the condition.
What should an explanation at the end of a session include?
Topic 8 asks for plain, jargon-free language linked to the person: the likely cause, the diagnosis, the key impairments, contributing factors and any need for caution. It should lead into options and the person's preferences, then a summary of agreed actions and a check that the main points were understood.
Exam move
Practise the Four Habits on a friend in a five-minute mock consultation, timing each habit. Collect five closed questions from your case handouts and rewrite each as an open one. End every practice session by asking for a teach-back, so the habit feels natural before the viva and placements.
Keep a short script for the end of every session, analysis, options, preference, barriers and teach-back, and use it in tutorials until it no longer needs notes.
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