***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Important barriers to the wider implementation of shared decision making remain . The experiences of professionals who are skilled in this approach may identify how to overcome these barriers . AIMS To identify the experiences and views of professionals skilled in shared decision making and risk communication , exploring the opportunities and challenges for implementation . DESIGN OF STUDY Qualitative study . SETTING Gwent Health Authority . METHOD Exit interviews using focus group methodology with 20 GPs who had been in practice between 1 and 10 years , and participated in an explanatory trial lasting 6 months . The trial interventions comprised training in shared decision-making skills and the use of risk communication material s. The doctors consulted with up to 48 patients each ( mean = 40 , half of them audiotaped ) for the study . RESULTS The GPs indicated positive attitudes towards involving patients and described positive effects on their consultations . However , the frequency of applying the new skills and tools was limited outside the trial . Doctors were selective about when they felt greater patient involvement was appropriate and feasible , rather than seeking to apply the approaches to the majority of consultations . They felt they often responded to consumer preferences for low levels of involvement in decision making . Time limitations were important in not implementing the approach more widely . CONCLUSION The promotion of ' patient involvement ' appears likely to continue . Professionals appear receptive to this , and willing to acquire the relevant skills . Strategies for wider implementation of patient involvement could address how consultations are scheduled in primary care , and raise consumers ' expectations or desires for involvement OBJECTIVE Fibromyalgia syndrome ( FMS ) is a condition of chronic widespread pain that is difficult to control and is associated with strains in physician-patient interaction . Shared decision making ( SDM ) can be a potential solution to improve interaction . We evaluated the effects of an SDM intervention , including an SDM communication training program for physicians , in a r and omized controlled trial with FMS patients . The main objective was to assess whether SDM improves the quality of physician-patient interaction from patients ' perspective . METHODS Patients were r and omized to either an SDM group or an information-only group .  The SDM group was treated by physicians trained in SDM communication and had access to a computer-based information package ; the information-only group received only the information package and was treated by st and ard physicians . All patients were offered the same evidence -based treatment options for FMS . Patients were assessed with question naires on physician-patient interaction ( main outcome criteria ) and decisional processes . Physicians filled out a question naire on interaction difficulties . Assessment took place immediately after the initial consultation . RESULTS Data from 85 FMS patients ( 44 in the SDM group and 41 in the information-only group ) were analyzed . The mean age was 49.9 years ( S.D.=10.2 ) , and 91.8 % of patients were female . The quality of physician-patient interaction was significantly higher in the SDM group than in the information-only group ( P<.001 ) . We found no differences in secondary outcome measures . CONCLUSIONS SDM with FMS patients might be a possible means to achieve a positive quality of physician-patient interaction . A specific SDM communication training program teaches physicians to perform SDM and reduces frustration in patients BACKGROUND AND PURPOSE Shared decision-making ( SDM ) as a model in physician-patient interaction is gaining relevance in the German health system . By applying this model , mid- and long-term improvements are expected especially in the outcomes of chronic diseases . Up to now , there has hardly been any empirical data available in German health services research regarding the state and development of SDM . This study establishes a baseline and provides actual data on this subject based on a German-wide survey of end-stage renal disease ( ESRD ) patients . METHODS St and ardized German-wide survey of 6,614 patients with ESRD . The question naire included an instrument to measure the patients ' perceived involvement in care ( PICS ) which had been translated and vali date d before . RESULTS 82 % of the question ed patients feel their physicians facilitated involvement in decision making . 81 % of the patients actively inform themselves concerning their disease and treatment options . 69 % state that SDM has taken place . Age , years on dialysis and gender correlate with perceived involvement . CONCLUSION This paper provides a valid baseline for the prospect i ve research of SDM in ESRD . The results indicate that dialysis patients are willing to participate in the process of medical decision-making . Characteristics and preferences of the patients should be taken into account not only in everyday clinical interactions . They could be monitored systematic ally within the framework of quality management and used as potential for quality improvement 
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An example of this potential difficulty , from a healthcare provider perspective , is identifying the potential conflict that may develop when a patient 's preference is different from clinical practice guidelines .
Both patients and health care providers have noted improvement in relationships and improved interactions when shared decision-making is in evidence .
Along with this improved relationship and