What's in a name? Why Patient Decision Aids May Undermine What They Set Out To Do.

The term "patient decision aids" has been used by the shared decision-making research field for three decades, yet we argue it has undermined the goals it was designed to serve. The name carries two embedded problems: it positions patients as decision-makers - a role most do not recognize or want - and it frames tools as endpoints rather than as preparation for dialogue. Most patients perceive themselves as lacking the knowledge and standing to engage on equal terms with clinicians, making the label psychologically aversive for the very population it targets. Compounding this, these tools are predominantly built on expected utility theory, presenting numerical probabilities while neglecting the texture of lived experience, treatment burden, and the relational dimensions of medical choice. Clinicians, meanwhile, resist tools that appear to shift decision-making to patients, as if it were undertaken solely by patients and perhaps separated from clinical encounters. We contend that tools - designed explicitly to scaffold and initiate conversation rather than substitute for it - are equally effective and better aligned with how patients and clinicians actually wish to engage. We propose retiring the term "patient decision aids" in favor of names that signal shared purpose, such as "conversation preparation tools" or "conversation catalysts." Renaming alone will not resolve implementation failures, but it is a necessary first step in repositioning these tools as assets for both patients and clinicians.