Cite as: Crijnen AAM & Kraan, HF (2026, January 1). Presenting Solutions. Retrieved from https://www.maas-mi.eu/explanation/general-practice-somatic-care/presenting-solutions

From MAAS MI to Modern Practice

Presenting solutions is not about persuading; it is about helping patients understand, deliberate, and act. The structure below follows three MAAS Medical Interview phases of the encounter and emphasizes practical skills, common pitfalls that derail them, and why these behaviors matter for outcomes.

Help patients understand, deliberate, and act

What Is Presenting Solutions and Shared Decision Making?

You’re three hours into a busy morning clinic when Mrs. Chen asks, What would you do if you were me, doctor?

This moment captures something fundamental about modern medicine—but the systematic answer began decades before current terminology.

In 1984, Crijnen and Kraan developed the MAAS Medical Interview framework, introducing Presenting Solutions as a comprehensive approach to responding to patients’ requests for help (Crijnen & Kraan, 1984). This framework anticipated by more than a decade what would later emerge as the Shared Decision-Making movement in medical literature.

MAAS MI Presenting Solutions encompasses three essential phases:

Phase 1: Information Provision

• Explaining diagnosis in understandable terms
• Explaining causes and maintaining factors
• Providing prognosis information—with and without treatment.

Phase 2: Collaborative Decision-Making

• Exploring patient expectations about help
• Proposing solutions with alternatives
• Explaining how solutions fit the problem
• Discussing pros and cons
• Sharing sound internet resources to counter misinformation
• Exploring different opinions
• Assessing intention to comply.

Phase 3: Concrete Implementation

• Explaining advice in concrete behavioral terms
• Checking patient understanding
• Making specific follow-up appointments.

The MAAS-Mental Health version elaborates this, adding items about exploring how much responsibility patients take for treatment—both the method (effort, time, obligations) and the objectives (what they want to achieve)—and how important others might influence the proposed help (Kraan & Crijnen, 1984).

What modern medicine calls Shared Decision-Making represents primarily Phase 2 of this broader framework.

This isn’t just theoretical medicine. Studies show SDM improves medication adherence, reduces healthcare utilization, and increases patient satisfaction (Slyer, 2022; Clark et al., 2008).

Preferences About Treatment Choices Are Dynamic -You Better Be Informed

Patient preferences aren’t carved in stone.

A patient might refuse statins on Monday and request them on Friday. Their 45-year-old colleague just had a heart attack. Suddenly, prevention looks different.

Behavioral scientists call these dynamic preferences—they shift with new information, changing emotions, and evolving life circumstances (Tay et al., 2017). The MAAS framework anticipated this complexity through items like Explores different opinions and Asks for patient’s opinion about proposed help, recognizing that preferences need ongoing reassessment.

What does this mean for your practice?

• First, Presenting Solutions isn’t a one-time event—it’s an ongoing conversation, especially for chronic conditions.
• Second, patients changing their minds isn’t failure; it’s normal. Create space for this.
• Third, check in when circumstances change: Last time you wanted to avoid surgery. Now that physical therapy hasn’t helped, does that change how you’re thinking?

Essential Elements in Shared Decision Making

What makes SDM actually work? A systematic review of 53 SDM models identified essential components (Bomhof-Roordink et al., 2019):

• Describe treatment options clearly topped the list (corresponding to MAAS item Proposes solutions).
  • Present all reasonable choices, including watchful waiting.
• Make the decision together appeared in 75% of models (MAAS items Asks intends to comply).
  • This isn’t you deciding then explaining; it’s joint problem-solving.
• Elicit patient preferences and tailor information each appeared in 65% of models (MAAS items Explores expectations and Shares sound resources).
  • Generic patient education fails, personalized discussion works.
• Deliberate together (58% of models; MAAS item Discusses pros and cons).
  • Thinking through implications.
• Creat choice awareness (55% of models) is crucial (MAAS item Proposes solutions including no further treatment).
  • Many patients don’t realize they have options

The remarkable finding: these modern SDM components map almost perfectly to the MAAS framework developed four decades earlier (Crijnen & Kraan, 1984).

In Figure 1 you will find the phases with items in Presenting Solutions.

Practical Framework: The MAAS Presenting Solutions Structure

The MAAS framework provides 13 specific items that have remained stable over four decades. Here’s how they work in practice:

Phase 1: Information Provision

• Item 3.1: Explain diagnosis understandably
  • Translate medical language into everyday terms
  • Instead of Essential hypertension, explain Your blood pressure runs high, making your heart work harder than it should
• Item 3.2: Explain causes and maintaining factors
  • Connect symptoms to mechanisms
  • When blood sugar stays high, it’s like having syrup in your pipes instead of water
• Item 3.3: Give prognosis information—with and without treatment
  • Without treatment, high blood sugar damages blood vessels over years. With good control, we prevent that damage

Phase 2: Collaborative Decision-Making

• Item 3.4: Explore patient expectations
  • Use ICEE questions—Ideas, Concerns, Expectations, Effects on life (Hashim, 2017)
  • What concerns you most about starting insulin?
• Item 3.5: Propose solutions
  • We could try lifestyle changes first, add medication now, or combine both approaches (Pieterse, et al., 2022)
• Item 3.6: Explain how solutions fit the problem
  • Given your BP is 160/95 and you have diabetes, medication addresses both conditions simultaneously
• Item 3.7: Discuss pros and cons
  • Use BRAN framework—Benefits, Risks, Alternatives, Nothing (Hoque, 2024)
  • Medication works faster but means daily pills
• Item 3.8: Explore different opinions
  • Does this match how you see the problem?
• Item 3.9: Share sound internet resources (2024 addition)
  • Counter misinformation
  • This site explains diabetes well. Focus on the ‘Daily Management’ section.
• Item 3.10: Ask about intention to comply
  • On a scale of 1-10, how confident are you that you’ll follow through? If below 7, explore barriers.

• MAAS-MH Item: Explore responsibility patient takes
  • This treatment requires testing blood sugar twice daily. Can you commit to that? What changes are you hoping to see?
• MAAS-MH Item: Ask patient’s opinion about proposed help
  • How do you feel about this plan?
• MAAS-MH Item: Explore how important others influence help
  • How will your family react to daily insulin?

Phase 3: Concrete Implementation

• Item 3.11: Explain advice in concrete behavioral terms
  • Not Lose weight but Reduce portion sizes by half at dinner, track it in your phone
• Item 3.12: Check patient understanding
  • Tell me in your own words what you’ll do differently starting tomorrow
• Item 3.13: Make specific follow-up appointments
  • Let’s meet in four weeks. Call sooner if you get dizzy or develop a persistent cough.

Educational Advice

Good news: These skills develop rapidly with deliberate practice using the MAAS framework.

• Access MAAS tools directly
  • MAAS General Practice is under TOOLS at www.maas-mi.eu, accessible on your phone while talking with patients.
  • MAAS General Practice Self enables self-evaluation.
• Start with the structure
  • Pick one item—maybe 3.1 (explaining diagnosis understandably) or 3.12 (checking understanding)—and focus on it for a week
• Practice with peers
  • Role-play tricky scenarios using the 13-item MAAS structure (Shrivastava et al., 2024).
• Get structured feedback
  • The framework’s observable behaviors make feedback concrete and actionable. Use MAAS General Practice Self to score recorded consultations.
• Understand the full scope
  • Modern SDM courses often focus only on Phase 2. Decision Making. The complete structure reminds you that SDM sits between essential information provision and concrete implementation.

Limitations

Time pressure is real. The complete process takes longer initially, but saves time through better adherence (Hoque, 2024). Integrate items gradually.

Not all patients want involvement; some prefer directive care, especially in acute situations (Ostermann et al., 2019). Items 3.4 and 3.10 assess desired involvement level.

Health literacy varies. Item 3.12 (checking understanding) becomes critical with lower health literacy.

Cultural differences matter. In some cultures, family-based decision-making predominates (Alabdullah et al., 2022). MAAS-MH Item Explores important others’ influence addresses this.

Evidence isn’t always equipoise. When one option is clearly superior, the collaborative phase looks different, but information provision and implementation remain crucial.

Training gaps persist (Spinnewijn, 2024). The MAAS framework’s specificity—13 observable items with clear scoring criteria—makes it teachable and assessable.

Historical Context and Conclusion

The MAAS framework (1984) provided systematic structure for patient-physician interaction more than a decade before shared decision-making emerged as formal terminology. When Bomhof-Roordink and colleagues (2019) analyzed 53 SDM models decades later, the most prominent components mapped almost perfectly to items Crijnen and Kraan had specified in 1984.

Modern SDM literature typically focuses on the collaborative decision-making phase. However, the complete Presenting Solutions structure reminds us that effective shared decision-making requires three essential phases: information provision, collaborative decision-making, and concrete implementation with follow-through.

For busy residents, the MAAS framework offers practical advantages:

• 13 observable items make progress measurable;
• Tools are immediately accessible on your phone;
• Evidence shows that systematic attention to all three phases improves outcomes for both patients and physicians (Clark et al., 2008).

References

Alabdullah Y, Alzaid EH, Alsaad SS, Alolayan SW, Bah S, Aljoudi AS. Autonomy and paternalism in shared decision-making in a Saudi Arabian tertiary hospital: A cross-sectional study. Developing World Bioethics. 2022;22(3):163-170.

Bomhof-Roordink H, Gärtner FR, Stiggelbout AM, Pieterse AH. Key components of shared decision making models: a systematic review. BMJ Open. 2019;9(12):e031763.

Clark NM, Cabana MD, Nan B, Gong ZM, Slish KK, Birk NA, Kaciroti N. The Clinician-Patient Partnership Paradigm: Outcomes Associated With Physician Communication Behavior. Clinical Pediatrics. 2008;47(1):49-57.

Crijnen AAM, Kraan HF. The Maastricht History-Taking and Advice Scoring General Practice (MAAS GP) – Items & Manual for Scoring. 1984. Available at: www.maas-mi.eu

Hashim MJ. Patient-Centered Communication: Basic Skills. American Family Physician. 2017;95(1):29-34.

Hoque F. Shared Decision-Making in Patient Care: Advantages, Barriers and Potential Solutions. Journal of Brown Hospital Medicine. 2024;1(1):122787.

Kraan HF, Crijnen AAM. The Maastricht History-Taking and Advice Scoring in Mental Health (MAAS MH) – Items & Manual for Scoring. 1984. Available at: www.maas-mi.eu

Ostermann J, Brown DS, van Til JA, Bansback N, Marshall DA, Bewtra M. Support Tools for Preference-Sensitive Decisions in Healthcare: Where Are We? Where Do We Go? How Do We Get There? The Patient: Patient-Centered Outcomes Research. 2019;12(6):555-564.

Pieterse, A. H., Brandes, K., de Graaf, J., de Boer, J. E., Labrie, N. H. M., Knops, A., Allaart, C. F., Portielje, J. E. A., Bos, W. J. W., & Stiggelbout, A. M. (2022). Fostering patient choice awareness and presenting treatment options neutrally: a randomized trial to assess the effect on perceived room for involvement in decision. Medical Decision Making, 42(3), 375–386.

Shrivastava S, Shrivastava PS, Bankar N, Bandre GR, Mishra VH. Training Undergraduate Medical Students in Shared Decision Making: A Systematic Review. Journal of Pharmacy and Bioallied Sciences. 2024;16(Suppl 1):S24-S26.

Slyer JT. Shared decision-making to improve medication adherence. The Nurse Practitioner. 2022;47(6):11-14.

Spinnewijn L. Shared decision-making revisited [Dissertation]. 2024.

Tay E, Massaro S, Vlaev I. Toward a Behavioral Model of Shared Decision Making. Academy of Management Proceedings. 2017;2017(1):13986.