Lesson 4 of 7 · about 14 minutes

AI generated Sample content. Poéma created this with AI to show what the platform can do. The people aren’t real, and no one has reviewed it for accuracy, so please don’t rely on it for health decisions. We’ll replace samples with reviewed content as Poéma grows. Every lesson in this sample course is open to everyone. Join Poéma, it’s free

Talking about options

Many health decisions don’t have one single right answer. Should I start a medicine now or try changes first? Should I have this screening test? Surgery or physical therapy? Often there are a few reasonable paths, and the best one depends on what matters to you: your goals, your worries, your daily life, and how you feel about trade-offs.

That’s where shared decision-making comes in. It means you and your clinician work through the options together. Your clinician brings knowledge about the evidence and what’s medically reasonable. You bring knowledge of your values, priorities, and life. Neither one alone is enough for the best decision.

This step-by-step guide walks you through how to have that conversation.

Step 1: Check whether there’s a choice to make

Sometimes there’s a clear path. Often, though, there are options. A helpful first question is simply: “Are there other options, or is this the only reasonable one?” Asking doesn’t mean you disagree. It just opens the door to a conversation.

Step 2: Ask the BRAN questions

Choosing Wisely UK, a program supported by the UK’s Academy of Medical Royal Colleges, encourages people to use four simple questions known as BRAN:

  • Benefits: What are the benefits?
  • Risks: What are the risks?
  • Alternatives: What are the alternatives?
  • Nothing: What if I do nothing?

From my own experience, here are some follow-ups that can make the answers more concrete:

  • “How likely is that benefit, for someone in my situation?”
  • “How common is that risk, and how serious would it be?”
  • “What would waiting, or watching for a while, look like?”
  • “How would each option fit into my daily life, including cost, time, and side effects?”

“What if I do nothing?” can feel like a strange question to ask, but it’s a fair one. For some situations, waiting and watching is a reasonable choice. For others, it isn’t. Knowing which is which helps you understand the stakes.

Step 3: Share what matters most to you

Your clinician can’t know your priorities unless you share them. Before or during the visit, think about:

  • What am I hoping this decision will help with?
  • What worries me most about each option?
  • What would I most like to avoid?
  • Are there practical things, like work, caregiving, transportation, or cost, that affect what’s realistic?

You might say, “Staying active matters most to me,” or “I’m worried about side effects that make me tired,” or “Fewer appointments would really help right now.” Statements like these help your clinician tailor the conversation.

Step 4: Use a decision tool

Decision aids are tools, such as booklets, videos, or websites, that lay out options, benefits, and risks in a balanced way and help you think about what matters to you. They’re designed for specific decisions, like whether to have a certain screening test or which treatment to choose for a particular condition.

The evidence for them is strong. A 2024 Cochrane systematic review led by Dawn Stacey looked at 209 randomized trials with more than 107,000 participants. Compared with usual care, people who used decision aids:

  • knew more about their options (high-certainty evidence),
  • had more accurate expectations about benefits and risks (high-certainty evidence),
  • felt better informed and clearer about what mattered to them, with less decisional conflict, and
  • were more involved in decisions, with fewer decisions made mainly by the clinician.

The review found no difference in decision regret, and found no evidence that decision aids caused harm. When decision aids were used during the visit, the visit lasted only slightly longer, about a minute and a half on average.

You can ask your clinician, “Is there a decision aid for this choice?”

Step 5: Try the Ottawa Personal Decision Guide

If there isn’t a decision aid for your exact situation, a general tool can still help. The Ottawa Personal Decision Guide is a free, two-page guide that works for almost any health or social decision. It walks you through:

  1. naming the decision you’re facing,
  2. what you know about your options,
  3. what matters most to you, and
  4. planning your next steps, including sharing your views with others involved.

It’s available in more than 15 languages and can be used without asking permission for personal use. The group that makes it notes that it’s a general guide, not a full decision aid for a specific condition.

Step 6: You don’t have to decide on the spot

For many decisions (not emergencies), it’s okay to ask, “How much time do I have to decide?” and “Can I think about this and get back to you?” You might want to talk it over with family, review a decision aid at home, or write down follow-up questions. If you take time, ask how to reach your clinician with your decision or questions.

Step 7: Confirm the plan

Once you’ve decided, use teach-back to make sure you’re on the same page: “So we’re going to try this for three months and then check in. If I notice these side effects, I’ll call.” It’s also worth asking how you’ll know if the plan is working.

A gentle reminder

Shared decision-making doesn’t mean you have to become an expert or make hard choices alone. Some people want to be deeply involved in every detail; others prefer to lean on their clinician’s recommendation. Both are okay. What matters is that the decision reflects what’s important to you, and that you understand what you’re choosing.

Sources

This guide is general education about how health decisions are made together. It’s not a recommendation about any decision you’re facing; that conversation belongs with your own clinician.

Education, not medical care. This was shared by a Verified Poéma Professional so you can learn. It’s their own professional view, not Poéma’s, and it isn’t guidance for your own situation. For questions about your health, talk with your own clinician. In an emergency, call 911.

Something here not seem right? Report a concern privately to the Poéma team.

PreviousNext