Shared Decision Making in the Era of Telehealth: Implications for Practice and Research.

Since its emergence in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID19), has infected over 14 million individuals worldwide. This unprecedented pandemic has forced clinicians to rethink how health care can be delivered to minimize the risk of disease transmission and promote patient safety while still meeting the general health needs of patients. As a result, telehealth visits (either by telephone or telehealth audio and video platforms) have become the preferred mode for many encounters. It seems increasingly likely that such telehealth visits will persist long after the pandemic has abated, resulting in the need to assess the impact of this change on clinical care and patientcentered research. Shared decision making (SDM) refers to the process by which clinicians and patients work through clinical problems together to arrive at decisions that make emotional, practical, and intellectual sense for the patient. This process is highly dependent on clear and unhurried communication. Effective SDM is essential to patientcentered care and is recommended by many professional societies when confronted with particular medical decisions. However, how to best implement SDM remains unknown. Strategies that rely on decision aids or patienteducation materials have been developed, but uptake of these tools remains low in clinical practice. What does the current shift toward telehealth in care delivery mean for SDM? Can technology be leveraged to facilitate effective SDM? Will this shift minimize or exacerbate health care disparities? What does this change mean for how researchers study SDM? In this commentary, we explore these questions from the perspectives of clinicians and researchers.