While there is consensus that shared decision-making should be an integral part of healthcare, there is ongoing debate about its philosophical and pragmatic aspects.

Shared decision-making was initially conceived as a process that involved communicating evidence-based options to address a health problem, the pros and cons of each option, eliciting the patient’s preferences and reaching a shared decision about the next steps to handle the problem.1

Some of the understanding of shared decision-making arises from research studies that have addressed specific questions and some occurs through iterative processes, which are often generated from debate and analysis articles. For a relatively young field, almost three decades since the publication of one of its foundation articles,1 both processes provide valuable opportunities for refinement and advances in understanding. Articles published in the shared decision-making series of BMJ evidence-based medicine highlight some of these issues.

The nature and application of shared decision-making continue to be refined, particularly in situations where the approach is bound by ethical, professional or societal considerations. For example, some challenges include …