Shared decision-making (SDM) is a process through which patients and providers collaborate to select a treatment option that aligns with patients' preferences and clinical context. SDM can improve patients' decision quality and satisfaction. However, vulnerable populations face barriers to participation in SDM, which exacerbates disparities in decision quality. This perspective article discusses SDM with vulnerable patients, using examples from patients who made decisions about postmastectomy breast reconstruction. We offer several strategies for clinical practice, medical education, and research to ensure that movements to engage patients in SDM do not exclude already marginalized groups.
