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Critical Care Medicine www.ccmjournal.org 1279 In this issue of Critical Care Medicine, members of the Section on Ethics of the European Society of Intensive Care Medicine published their systematic review and expert position statement regarding what they have termed “interprofessional shared decision-making (IP-SDM)” (1). Their primary question was “Should IP-SDM vs. no IP-SDM be used in the care of critically ill patients.” Before proceeding any further, it is crucial that we carefully define the difference between IP-SDM and interdisciplinary shared decision-making (ID-SDM): IP-SDM refers to interactions among clinicians of different professions (e.g., nurses, physicians, pharmacists, respiratory therapists, registered dietitians), whereas ID-SDM relates to communication and interactions among clinicians of the same profession (e.g., surgeons, internists, anesthesiologists), with this article focusing on IP-SDM. Their primary outcomes were divided into two areas: patient and family-centered outcomes (satisfaction, quality of communication, quality of dying, and psychologic symptoms) and clinician-centered outcomes (interprofessional collaboration, interprofessional satisfaction with decision-making, moral distress, burnout, job satisfaction, and intention to leave the profession). As the authors state, they made recommendations (rather than present the results of a formal meta-analysis) due to the profound heterogeneity (and low quality) of the studies analyzed. They did an initial screen of 1,162 abstracts, of which 43 underwent a preliminary evaluation. Of those articles, only four met the final formal criteria for selection into a detailed analysis in their systematic review (2–5). To briefly summarize their findings, overall they found a correlation between the degree of clinician collaboration and satisfaction with clinical decisions (2), improved perception of quality of care with interdisciplinary meetings (3), decreased moral distress with improved nurse-physician collaboration (4), and improvement in perceived “organizational factors” and “care processes” with an intervention to improve ICU teamwork (5). The authors then went on to make five recommendations regarding IP-SDM: recommendation 1 related to the definition of IP-SDM, emphasizing the importance of team-based decision-making in the ICU, while simultaneously taking into account best evidence, combined team expertise and experience, as well as—with great significance—the values, goals, and preferences of the patient. They stressed the differences between shared decision-making with patients and families and IP-SDM, and also the importance of speaking to families with “one voice” whenever possible. Recommendation 2 articulated that ICU clinicians consider engaging in IP-SDM to encourage the most appropriate decisions. They describe that decisions can go from level 1 (made by an individual clinician) to level 4 (full IP-SDM). The authors do acknowledge that the final decision in the ICU may frequently rest with one particular individual, but that this does not diminish the relevance or value of IP-SDM. Recommendation 3 was that a culture (or climate) be created that fosters and encourages IP-SDM in the ICU setting. They point out that ICU physicians in particular must work to use the IP-SDM model when making decisions, acknowledging that this may in some instances take more time than other forms of decision-making. Recommendation 4 was to use the VALUE-TEAM paradigm when making decisions (Table 1), and that this structured approach can help to remind clinicians the importance of mutual respect as well as taking the time to gain the input from the various members of the ICU team. Recommendation 5 was that further studies should be performed regarding the true value of IP-SDM in the ICU as well as the optimal outcomes in these kinds of studies. They indicated that the overall quality of evidence for this particular area was “very low.” What is the “value added” of the current systematic review and expert panel recommendations on IP-SDM by Michalsen et al (1)? How should it inform clinical practice? Given the audience of Critical Care Medicine, we feel there is significant value in an article with an emphasis on this important topic. Also, it was an interesting paradigm to separate out “interprofessional” from “interdisciplinary.” It has been the recommendation (and a crucial part of the mission statements) for many years from all the members of the Critical Care Societies Collaborative (Society of Critical Care Medicine, American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society) that the ICU interprofessional team work closely in a tightly integrated fashion to *See also p. 1258.