Shared decision making in social services - some remaining questions

Recent years have seen increased emphasis on person-centring and user involvement in healthcare delivery and social services. In Sweden, the rights of users to participate in and influence care planning and services are stipulated in the Social Services Act, the Health Care Act and the Patient Law. Shared decision making (SDM) is presented as a supportive collaboration between users and staff, drawing on users' preferences and values as well as the best available evidence to discuss options and reach a consensus on care decisions. However, studies on the implementation of SDM in somatic care illustrate challenges, such as staff trying to persuade users to agree to a particular option rather than offering opportunities to discuss various alternatives. The Swedish National Board of Health and Welfare recommend that SDM should be offered in social services support in relation to certain groups. However, the imperative that 'SDM should be offered in the social services' raises questions; in addition to the question of how SDM should be understood, we need to account for why SDM should be offered, who should offer SDM, when it should be offered, to whom and regarding which decisions. The questions concern justification as well as clarifications. The aim of this article is threefold: to discuss SDM and its components; to deliberate upon what SDM may imply to the social services and finally, to suggest some preconditions that should be present for an implementation of SDM.