Shared decision-making and physicians’ duty to explain and their ethical and legal implications for the reduction of medical litigation risk: a narrative review

Purpose: Shared decision-making (SDM) is a core element of patient-centered care; however, traditional approaches to informed consent and physicians’ duty to explain have often remained procedural and predominantly physician-driven. This review aims to examine how SDM substantively strengthens the physician’s duty to explain and how it may contribute to reducing medical litigation risk while simultaneously improving patient–physician relationships.Current concepts: SDM is a collaborative process in which patients and physicians jointly consider available treatment options, relevant medical evidence, and patients’ individual values and preferences. Evidence from systematic reviews indicates that SDM improves patients’ knowledge, promotes more realistic expectations, reduces decisional conflict, and enhances satisfaction and trust. From a legal perspective, inadequate communication and information asymmetry constitute major contributors to medical disputes. By emphasizing meaningful dialogue, documenting deliberative processes, and incorporating patient decision aids, SDM reframes informed consent from a largely formal requirement into an interactive process that supports patients’ substantive understanding and autonomous decision-making.Discussion and conclusion: Although direct evidence demonstrating that SDM reduces medical errors remains limited, existing findings suggest that SDM may mitigate structural causes of medical disputes by addressing communication failures and unmet patient expectations. By reinforcing the physician’s duty to explain in a substantive and patient-centered manner and by fostering a trust-based therapeutic alliance, SDM has the potential to reduce medical litigation risk. Integrating SDM into routine clinical practice through education, institutional support, and supportive legal frameworks may represent an emerging standard for fulfilling physicians’ duty to explain and for promoting sustainable patient–physician relationships.