A patient can understand a treatment and still be unsure whether they want it.
They may know why a medication has been prescribed, what benefit it is expected to provide and which side effects are possible. They may even repeat the instructions correctly. What we still do not know is whether the treatment works for them: whether its disadvantages are acceptable, whether it fits their daily life, or whether another clinically appropriate option would suit their priorities better.
That is the space in which shared decision-making in healthcare becomes important. It is a fundamental part of patient-centred communication because understanding a treatment and participating in a treatment decision are not the same thing.
Explaining treatment gives patients information. Shared decision-making goes further. It uses that information as the basis for a conversation in which clinical expertise and the patient’s priorities are brought together to reach a workable plan.
Explaining a Treatment Is Not the Same as Making a Decision Together
Treatment discussions naturally involve explanation. Patients need to understand their condition, the available treatment, likely benefits, possible risks or side effects, and what treatment may involve in practical terms.
But a clinician can communicate all of this clearly and still conduct a largely one-way conversation.
“This medication should help control your symptoms. You need to take it twice a day, and it can occasionally cause dizziness.”
“There are a couple of ways we could manage this. I can explain the differences, and then we can look at which option might work better for you.”
The clinical information has not changed. The patient’s role has.
Shared decision-making begins when treatment stops being something that is simply explained to the patient and becomes something that is discussed with the patient.
For nurses and other healthcare professionals, this distinction is particularly important. Strong healthcare communication skills are not demonstrated simply by delivering accurate information. They also involve checking how the patient has interpreted that information and creating an opportunity for meaningful participation.
A Good Treatment on Paper May Not Be the Best Fit for a Patient
Clinical evidence can tell us a great deal about a treatment. It cannot tell us exactly how an individual patient will value its advantages and disadvantages.
Imagine two patients considering a medication that may cause drowsiness. One works from home and feels that occasional drowsiness would be manageable if the medication substantially improves their symptoms. The other drives for a living. For that patient, the same side effect may interfere with work, income and independence.
The medical information is identical. Its importance to each patient is not.
The same principle applies to treatment schedules, recovery periods, pain, mobility, fertility concerns, dietary restrictions, cost, caring responsibilities and many other aspects of healthcare.
This is why asking, “Do you understand the side effects?” does not complete the conversation.
“Is there anything about these side effects that would be particularly difficult for you?”
“How do you think this treatment would fit into your usual routine?”
These questions uncover information that cannot be found in a clinical guideline or drug information sheet. They tell us what the treatment may mean in the context of the patient’s actual life.
Patients Need to Know When There Is a Choice
Shared decision-making becomes difficult if the patient does not realise that more than one reasonable option exists.
There is a considerable difference between:
“We’ll start you on Treatment A.”
“There are two treatment options that would be reasonable in your situation. They have different advantages and disadvantages, so let’s go through them.”
The second approach does not diminish professional expertise. It simply makes the decision visible.
Where genuine alternatives exist, patients should have an opportunity to understand them. Depending on the clinical situation, the possibilities may include different treatments, delaying a decision, continuing current management or, in some circumstances, choosing not to have a particular treatment.
That does not mean presenting every theoretical possibility. The clinician still has an important role in identifying which options are clinically appropriate.
Present the Options Before Trying to Solve the Decision
How treatment choices are introduced can influence the conversation before the patient has had a chance to consider them.
“I think Treatment A is the best choice. We could use Treatment B if you really don’t want A.”
“There are two reasonable options here. Let me explain what each involves, including the main benefits and drawbacks. Then we can talk about which may suit you better.”
Treatment B has technically been mentioned in the first version, but it has not been presented in the same way.
There will, of course, be situations in which one option is clinically preferable and the healthcare professional should say so. Shared decision-making does not require clinicians to conceal professional judgement.
What matters is the distinction between making a recommendation and making the patient’s decision for them. A clinician can explain, “For these reasons, I would recommend this option,” while still inviting the patient to ask questions, express concerns and discuss whether the recommendation is acceptable.
Risks and Benefits Need Context
Patients frequently hear that a treatment has “risks and benefits.” Those words alone are not particularly useful.
What is the likely benefit? How significant is the risk? What might the side effect actually mean for everyday life? Are there differences between the available options that matter to this patient?
Risk communication becomes especially difficult when statistics are involved. A technically accurate number can still be misunderstood if it is given without enough context.
For example, saying that something “doubles the risk” sounds dramatic. If the underlying risk changes from 1 in 1,000 to 2 in 1,000, knowing the absolute figures gives the patient a much clearer basis for considering that information.
Good treatment communication therefore involves more than listing risks. Information needs to be understandable, proportionate and relevant to the decision being made.
More Information Does Not Always Mean Better Communication
Healthcare professionals understandably want patients to be well informed. Sometimes that leads to too much information being delivered at once.
Imagine hearing, within a few minutes, a new diagnosis, three treatment choices, several possible complications, medication instructions, lifestyle advice and follow-up arrangements. Even an attentive patient may struggle to process all of it.
A more useful approach is to prioritise the information and provide it in manageable sections. Explain one part, pause, check how the patient is following, answer questions and then continue.
“That’s quite a lot about the first option. Before I explain the second one, what would you like me to clarify?”
This creates space for the patient to think rather than simply receive. It also gives the healthcare professional valuable information. The patient’s questions may reveal what they have understood, what they have misunderstood and what matters most to them.
“Do You Understand?” Often Tells Us Very Little
One of the easiest ways to check understanding is also one of the least informative: “Do you understand?” The answer will often be yes.
A patient may genuinely understand. They may think they understand. They may feel uncomfortable admitting that they are confused. They may simply want the conversation to move on.
A better check invites the patient to explain the information in their own words.
“I’ve given you quite a lot of information. Just so I know I’ve explained it clearly, can you tell me what you understand about the two options?”
This is not an examination of the patient. It is a check on the effectiveness of the explanation.
The difference is subtle but important. Rather than making the patient responsible for declaring that they do not understand, the healthcare professional takes responsibility for making the information understandable.
The same principle can be used when confirming the final treatment plan.
Understanding the Options Still Doesn’t Tell Us What the Patient Values
Suppose the patient now understands both treatments perfectly. There is still a decision to make.
At this stage, repeating the medical information may add little. The clinician needs another type of information: what matters to this patient?
One person may prioritise avoiding pain. Another may be willing to tolerate more discomfort for a shorter recovery. Someone may be concerned about returning to work quickly. Another patient may be caring for a family member and unable to attend frequent appointments. A side effect that appears relatively minor clinically may be unacceptable because of its effect on the patient’s occupation or lifestyle.
Questions such as these can change the quality of the discussion:
“What matters most to you when you’re considering these options?”
“Which part of the treatment concerns you most?”
“Is there anything in your daily life that would make one of these options difficult?”
The healthcare professional brings knowledge of disease and treatment. The patient brings knowledge of their own life.
This is one of the central principles of patient-centred care and patient involvement in healthcare decisions: clinical expertise and personal priorities answer different parts of the same question. A genuinely shared decision needs both.
Patient involvement is sometimes misunderstood as: “Here are your options. It’s entirely up to you.” That can feel less like empowerment and more like abandonment, particularly when the decision is complex or frightening.
Patients differ in how much responsibility they want to take in a healthcare decision. Some want detailed information and a strong role in choosing. Others want the clinician’s recommendation. The same person may want considerable independence in one situation and much more professional guidance in another.
A useful question may therefore be:
“Would you like me to tell you which option I would recommend and why?”
This preserves professional expertise without assuming that the clinician’s preference automatically becomes the patient’s choice.
In practice, shared decision making in nursing and other healthcare settings does not require the professional to withdraw their expertise. Patients may still want a recommendation, an explanation of why one option may be preferable, or help weighing competing considerations.
Shared decision-making sits between two unhelpful extremes: “I’m the healthcare professional, so I decide” and “You’re the patient, so you decide.” The better conversation is collaborative: this is what the clinical evidence suggests; these are the reasonable options; tell me what matters to you, and let’s work out how those things fit together.
How to Involve Patients in Treatment Decisions When They Disagree
Treatment refusal is one of the situations in which communication becomes especially important.
It is easy to interpret refusal as non-compliance: “The patient won’t take the medication.” But that statement tells us almost nothing about why.
Perhaps the patient experienced a serious side effect from a similar drug previously. Perhaps they are frightened by something they read online. Perhaps treatment interferes with work. Perhaps cost is a problem. Perhaps they have misunderstood the purpose of the medication. Perhaps their concern is cultural or religious. Or perhaps, after understanding the options, they simply value the benefits and disadvantages differently.
Repeating the same explanation more firmly may not resolve any of those problems.
A more productive question is:
“Can you tell me what worries you most about taking it?”
Refusal should not automatically end the conversation, but neither should it turn the consultation into a contest that the healthcare professional needs to win.
Exploring the reason gives the clinician an opportunity to correct misinformation, answer questions, discuss alternatives or understand a patient’s preference more accurately.
Negotiation Is Different From Persuasion
This distinction becomes particularly clear with lifestyle advice.
“Stop smoking.” “Lose weight.” “Exercise more.” “Reduce your alcohol intake.” These may all be medically appropriate recommendations. But none of them is a practical plan.
Suppose a patient who smokes twenty cigarettes a day says they cannot imagine stopping immediately. Repeating the health consequences of smoking may increase knowledge without changing behaviour.
A conversation about what the patient feels able to attempt, what has prevented previous attempts, what support is available and what realistic first step could be agreed is fundamentally different.
Persuasion begins with the clinician’s preferred outcome and tries to obtain agreement. Negotiation asks whether the clinician and patient can reach a clinically appropriate plan that the patient can realistically follow.
A patient who says “yes” in the consultation but has no intention or ability to follow the plan has not necessarily participated in a successful treatment discussion.
Agreement Needs to Be Checked Too
Even when both people believe a decision has been made, they may leave with different understandings of what happens next.
The clinician may think: Take the medication twice daily for six weeks. The patient may have understood: Take it until the symptoms disappear.
That is why the end of the conversation matters.
Before closing, it can be useful to establish what has actually been agreed: what the patient will do, what the healthcare team will do, when follow-up is expected, what problems should prompt further help, and when the decision will be reviewed.
The patient can also be invited to summarise the plan in their own words.
Shared decision-making is not complete simply because somebody has said, “Okay.”
Some Decisions Need More Than One Conversation
Patients do not always need to decide immediately.
A person receiving unfamiliar or emotionally difficult information may need time to think. They may want to discuss the options with family, read further information, consider the effect on work or caring responsibilities, or return with additional questions.
Where the clinical situation allows it, giving someone time can be part of good decision-making rather than evidence that the consultation has failed.
Decision aids, written information and follow-up discussions can support this process, but they do not replace the conversation itself.
The objective is not to force every decision into a single appointment. It is to help the patient reach an informed decision at an appropriate point.
There are useful phrases for involving patients: “How does that sound to you?”, “Which option would you prefer?” and “What concerns you most?” But patient-centred communication cannot be reduced to inserting these sentences into a consultation.
A healthcare professional could ask, “What do you think?” and then immediately dismiss the answer.
The real skill lies in what happens after the patient responds.
Does the clinician explore the concern? Does new information change the discussion? Is a misunderstanding corrected? Are the options reconsidered? Is the patient’s priority reflected in the eventual plan?
Shared decision-making therefore requires judgement as much as language. The healthcare professional needs to know when to explain, when to pause, when to ask, when to recommend, when to clarify and when to listen.
Why This Matters for OET Preparation and Internationally Qualified Healthcare Professionals
For internationally qualified nurses and other healthcare professionals, shared decision-making may involve adjusting not only language but also expectations about the clinician-patient relationship.
Healthcare cultures differ. Some professionals have trained in systems where clinicians traditionally take a more directive role in treatment decisions. Some patients also expect that approach and may actively ask the healthcare professional to decide for them. Other patients expect to question recommendations, compare alternatives and participate closely in treatment planning.
Neither preference should simply be assumed.
For an internationally qualified healthcare professional, adapting successfully means learning how to create space for patient participation without withdrawing appropriate clinical guidance.
This is also why effective OET preparation should go beyond learning useful expressions for a role play. Candidates looking for OET speaking tips, online OET classes or online OET coaching often focus initially on what they should say. Yet strong healthcare communication also depends on what happens after the patient responds: whether the healthcare professional explores a concern, checks understanding, offers appropriate choices and adapts the conversation accordingly.
Free OET materials can be useful for practising language and becoming familiar with different clinical scenarios, but communication skills develop through understanding the purpose behind that language. Memorising an empathetic phrase, for example, is very different from recognising when a patient’s concern should influence the treatment discussion.
For nurses eventually exploring jobs for nurses in Australia or jobs for nurses in New Zealand, these skills also have relevance beyond the OET exam. Patient-centred communication, treatment discussions and responding appropriately to patient preferences form part of everyday professional communication in healthcare environments.
Developing these healthcare communication skills can therefore be particularly important for professionals adapting to patient-centred healthcare environments in countries such as Australia, New Zealand, the UK, Ireland, Canada and the USA.
This also explains why good performance in OET or another communication assessment cannot depend entirely on polished phrases. A healthcare professional might explain a treatment beautifully and still miss the patient’s concern. They might offer several options without discovering what the patient values. They might ask for the patient’s preference without checking whether the patient understood the choices. Or they might acknowledge the patient’s opinion but continue with exactly the same plan without considering whether that opinion should affect it.
The deeper communication question is not simply, “Did I explain the treatment clearly?” It is: “Did the patient have a meaningful role in what happened next?”
The Conversation After the Explanation Matters Most
A good treatment discussion should leave both people knowing more than they knew at the beginning.
The patient should understand the relevant options, their likely benefits and disadvantages, and what each may involve. They should have had the opportunity to ask questions and express concerns.
The healthcare professional should have learned something too: what the patient hopes to achieve, what worries them, what they may find difficult, and which considerations matter most in choosing between reasonable options.
That is why explaining treatment is only half the conversation.
Clinical evidence can identify appropriate choices. Professional expertise can help a patient understand those choices and their consequences.
But choosing between reasonable alternatives often requires something that neither a textbook nor a guideline can provide: an understanding of the person who will actually have to live with the decision.
FAQs
Shared decision-making is a collaborative approach in which healthcare professionals and patients consider clinically appropriate options together. Clinical evidence and professional expertise are combined with the patient’s preferences, circumstances, concerns and priorities when developing a treatment or care plan.
Not entirely. Healthcare professionals remain responsible for providing appropriate clinical information, explaining reasonable options and offering professional recommendations when needed. The patient contributes their own priorities and preferences. The aim is to reach an informed and clinically appropriate decision together.
They are related but not identical. Informed consent requires a patient to receive and understand relevant information before agreeing to an intervention. Shared decision-making describes a broader collaborative process of considering reasonable options and deciding which approach best fits the patient’s circumstances and preferences.
What if a patient refuses the treatment recommended by the healthcare professional?
The reason for the refusal should be explored rather than automatically treating it as a communication failure or lack of cooperation. The patient may have concerns, misconceptions, previous experiences or practical circumstances influencing the decision. Healthcare professionals can clarify information and discuss consequences and alternatives while respecting the patient’s role in decision-making within the applicable clinical and legal framework.
How can nurses involve patients in treatment decisions?
Nurses can support patient involvement by explaining information clearly, checking understanding, identifying concerns and practical barriers, encouraging questions and exploring what matters to the patient. Their role will vary according to the clinical situation and scope of practice, but effective communication can help patients participate more meaningfully in decisions about their care.
Treatment decisions are not discussed only during medical consultations. Nurses and other healthcare professionals frequently explain care, reinforce information, identify concerns, check understanding and discover practical barriers that may affect a treatment plan. Strong shared decision-making skills therefore form part of effective patient-centred communication across healthcare settings.
About Khaira Education Services
When healthcare professionals search for the best OET coaching, the focus is understandably often on achieving the required OET score. At Khaira Education Services, OET preparation and healthcare communication training also recognise the larger purpose of these skills: communicating effectively with real patients and colleagues after the exam.
KES supports internationally qualified healthcare professionals through OET preparation, online OET classes, online OET coaching and practical communication training designed around the demands of healthcare communication.