000307580 001__ 307580 000307580 005__ 20260110120408.0 000307580 0247_ $$2doi$$a10.1007/s00103-025-04176-5 000307580 0247_ $$2pmid$$apmid:41504883 000307580 0247_ $$2ISSN$$a0007-5914 000307580 0247_ $$2ISSN$$a1436-9990 000307580 0247_ $$2ISSN$$a1437-1588 000307580 037__ $$aDKFZ-2026-00075 000307580 041__ $$aGerman 000307580 082__ $$a610 000307580 1001_ $$aGeiger, Friedemann$$b0 000307580 245__ $$aA matter of the system: how shared decision making is self-scaling across the healthcare system. [Eine Frage des Systems: Wie sich Shared Decision Making von selbst im Gesundheitssystem skaliert.] 000307580 260__ $$aHeidelberg$$bSpringer$$c2026 000307580 3367_ $$2DRIVER$$aarticle 000307580 3367_ $$2DataCite$$aOutput Types/Journal article 000307580 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1767965916_3737039$$xReview Article 000307580 3367_ $$2BibTeX$$aARTICLE 000307580 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000307580 3367_ $$00$$2EndNote$$aJournal Article 000307580 500__ $$aPatientenbeirat Deutsches Krebsforschungszentrum, Heidelberg, Deutschland / epub 000307580 520__ $$aShared decision making (SDM) is still scarcely implemented in Germany-a statement that could have served as an appropriate opening line of literally any article on SDM during the last decades. But why? Today, SDM is regarded as the gold standard for reaching decisions about the most suitable treatment, a view reinforced by the German Patients' Rights Act. How can it be that SDM nonetheless has not gained noticeable traction in medical practice?Drawing on the framework of synergetics, this article outlines which factors within the German healthcare system are responsible for this stagnation and how those same factors can be utilized to foster the emergence of SDM. As empirical evidence for this analysis, the Kiel Model demonstrates how SDM was implemented hospital-wide through the SHARE TO CARE program and was operationalized as a reimbursable service covered by health insurance. Its positive effects on quality of care and cost-effectiveness enabled a self-sustaining and thus sustainable SDM infrastructure.Finally, the article describes which simple regulatory adjustments by legislation would allow SDM to scale across hospitals nationwide through self-organization following the Kiel Model. 000307580 536__ $$0G:(DE-HGF)POF4-319H$$a319H - Addenda (POF4-319H)$$cPOF4-319H$$fPOF IV$$x0 000307580 588__ $$aDataset connected to CrossRef, PubMed, , Journals: inrepo02.dkfz.de 000307580 650_7 $$2Other$$aCost efficiency 000307580 650_7 $$2Other$$aKiel Model 000307580 650_7 $$2Other$$aQuality of care 000307580 650_7 $$2Other$$aSelf-organisation 000307580 650_7 $$2Other$$aSynergetics 000307580 7001_ $$aOldenburg, Martin$$b1 000307580 7001_ $$0P:(DE-HGF)0$$aFörner, Johannes$$b2 000307580 7001_ $$aMandelkow, Lars$$b3 000307580 773__ $$0PERI:(DE-600)1470303-8$$a10.1007/s00103-025-04176-5$$pnn$$tBundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz$$vnn$$x0007-5914$$y2026 000307580 909CO $$ooai:inrepo02.dkfz.de:307580$$pVDB 000307580 9101_ $$0I:(DE-588b)2036810-0$$6P:(DE-HGF)0$$aDeutsches Krebsforschungszentrum$$b2$$kDKFZ 000307580 9131_ $$0G:(DE-HGF)POF4-319H$$1G:(DE-HGF)POF4-310$$2G:(DE-HGF)POF4-300$$3G:(DE-HGF)POF4$$4G:(DE-HGF)POF$$aDE-HGF$$bGesundheit$$lKrebsforschung$$vAddenda$$x0 000307580 9141_ $$y2026 000307580 915__ $$0StatID:(DE-HGF)3002$$2StatID$$aDEAL Springer$$d2024-12-09$$wger 000307580 915__ $$0StatID:(DE-HGF)3002$$2StatID$$aDEAL Springer$$d2024-12-09$$wger 000307580 915__ $$0StatID:(DE-HGF)0200$$2StatID$$aDBCoverage$$bSCOPUS$$d2024-12-09 000307580 915__ $$0StatID:(DE-HGF)0300$$2StatID$$aDBCoverage$$bMedline$$d2024-12-09 000307580 915__ $$0StatID:(DE-HGF)0100$$2StatID$$aJCR$$bBUNDESGESUNDHEITSBLA : 2022$$d2024-12-09 000307580 915__ $$0StatID:(DE-HGF)0199$$2StatID$$aDBCoverage$$bClarivate Analytics Master Journal List$$d2024-12-09 000307580 915__ $$0StatID:(DE-HGF)0160$$2StatID$$aDBCoverage$$bEssential Science Indicators$$d2024-12-09 000307580 915__ $$0StatID:(DE-HGF)0113$$2StatID$$aWoS$$bScience Citation Index Expanded$$d2024-12-09 000307580 915__ $$0StatID:(DE-HGF)0150$$2StatID$$aDBCoverage$$bWeb of Science Core Collection$$d2024-12-09 000307580 915__ $$0StatID:(DE-HGF)9900$$2StatID$$aIF < 5$$d2024-12-09 000307580 9201_ $$0I:(DE-He78)W510-20160331$$kW510$$lBibliothek$$x0 000307580 980__ $$ajournal 000307580 980__ $$aVDB 000307580 980__ $$aI:(DE-He78)W510-20160331 000307580 980__ $$aUNRESTRICTED