**5. Shared decision-making process**

In recent days, there is a shift of interest and additional research on this new doctor-patient relationship. This new alliance is based on co-operation rather than confrontation, in which the doctor must "understand the patient as a unique human being" [8]. Thus, patient-centered care has replaced the one-sided, doctordominated relationship in which the exercise of power distorts the decision-making process for both parties. This decision-making is based on a two-way process in which both the patient and the doctor share the information and the responsibility for decision-making. It applies to most visits, as the majority of treatment decisions include several options, even if one of the options is a no-action or non-treatment. The shared decision-making (SDM) process has begun to be at the center of healthcare. Coulter and Collins [9] define SMD as *a process in which clinicians and patients work together [...] sharing information about options [...] with the aim of reaching mutual agreement on the best course of action.*

SDM includes at least one patient and one healthcare provider. Both parties take steps to actively participate in the decision-making process, share information and

personal values, and together they come to a shared responsibility decision [10, 11]. This process is indicated when there are multiple possible treatments and the alternatives have different and uncertain results, as is the case of most chronic diseases or if the outcome of the treatment is considered to be subjectively significant [12]. Furthermore, it might help the patient and the healthcare professional to conclude to a mutual agreement on treatment or other long-term decisions [13]. Chewning et al. [14] argue that greater patient involvement in management decisions is associated with fewer conflicting decisions, which can be considered moderate to patient satisfaction. SDM is associated with feelings of autonomy, control, and individual capacity from the patient. Actions for the implementation of SDM are becoming increasingly important and their results should be evaluated and measured.
