The document discusses patient shared decision making (SDM) at BIDMC for preference-sensitive orthopedic conditions. The goal is to enhance information exchange and empower patients to make effective healthcare decisions. Interventions included disseminating decision aids and health coaching to assess patients' knowledge and decisional conflict. Lessons showed inviting patients to participate in SDM is not enough and interventions need to meet patients physically, emotionally, and match their needs to foster trusting partnerships. Next steps include developing new SDM tools and integrating the framework seamlessly into existing workflows.