Shared decision-making is commonly taught as a communication competency, yet the work required in medicine-related decisions varies substantially across encounters. Explaining a medicine, eliciting what matters to a patient, negotiating disagreement, accepting an informed refusal, managing uncertainty, and determining whether a decision is closed or should be revisited place different cognitive, relational, ethical, and temporal demands on practitioners. Treating these demands as manifestations of one global communication skill can obscure meaningful differences in learner performance and weaken assessment validity. This conceptual article develops a six-domain shared decision-making capability taxonomy for pharmacy education and professional training. The taxonomy differentiates capabilities according to the immediate decision task, the object on which the practitioner must act, the observable evidence of competent performance, characteristic failure modes, and ethical or contextual limits. The six domains are explaining medicines; eliciting values and priorities; negotiating disagreement; respecting refusal; managing uncertainty and trade-offs; and closing and revisiting decisions. The domains are mutually informative but are not assumed to form a linear hierarchy. Competence in one domain may support another without establishing proficiency across the taxonomy. The proposed account therefore shifts assessment away from undifferentiated ratings of “communication” toward task-matched evidence of decision capability. Its central claim is deliberately testable: if performance across these tasks is effectively unidimensional after knowledge and scenario difficulty are controlled, the value of the taxonomy would be weakened. If meaningful within-learner dissociations persist, pharmacy education requires more differentiated teaching and assessment of shared decision-making.
