Many frameworks have been used to identify environmental flows for sustaining river ecosystems or specific taxa in the face of widespread flow alteration for human use. However, these methods mostly focus on identifying suitable flows and largely ignore the important links between management actions, resulting flows, flow variability, and ecosystem or social responses. Structured decision making (SDM) could assist the comparison and implementation of environmental flows by providing a framework to compare effects of flow management actions on objectives via environmental flow science. We describe the SDM process and illustrate its application using a case study focused on comparing environmental flow scenarios for the mainstem Willamette River, Oregon, USA. In a short timeframe, SDM was successfully applied to identify management objectives, develop empirical and expert opinion based models predicting ecological responses, and compare scenarios while accounting for uncertainty and partial controllability. We found that no flow scenario was clearly preferred based on available knowledge, largely because river flows could only be partially controlled through available dam operations. Participants agreed that the SDM process was useful and that an additional iteration focused on refining predictive models and incorporating additional objectives could help better inform dam release decisions for the entire basin. In our view, SDM can provide managers with more realistic comparisons of environmental flows by accounting for partial controllability and uncertainty, which may result in greater implementation of available flow management actions.