Abstract
Shared Decision Making (SDM), currently considered a preferred model for making decisions in healthcare, requires that patients have the knowledge and skills to actively participate in the consultation and decision-making process. Patients with limited health literacy (LHL) often fail to do so. To gain insight into the experiences, needs and support for LHL-patients concerning SDM in clinical practice, five focus groups were held with 26 patients with LHL. A focus group discussion guide was developed based on 4-steps SDM models. Data was coded using thematic content analyses. LHL patients participating in this study had little experience with SDM in practice, but do prefer it. Important barriers for this are healthcare provider-related (involving patients too little in decision-making, using medical jargon), patient-related (feeling insecure to play a role in decision-making, inability to understand their diagnosis or information about treatment options), patient-provider interaction-related (relationship of trust) or system-related (too little consultation time). For SDM to take place more often, a shared responsibility between patients and healthcare providers is required. We recommend expanding the SDM models, by adding a step zero (patients understand their diagnosis) and a fifth step (reviewing the decision), to improve the process for LHL patients.
Highlights
Shared Decision Making (SDM), currently considered a preferred model for making decisions in healthcare, requires that patients have the knowledge and skills to actively participate in the consultation and decision-making process
limited health literacy (LHL) patients participating in this study indicated that they had not experienced a treatment choice during their conversations with their healthcare providers, nor had they played a role in the decision making process
Barriers and facilitators of LHL patients related to the four steps of SDM will be discussed below
Summary
Shared Decision Making (SDM), currently considered a preferred model for making decisions in healthcare, requires that patients have the knowledge and skills to actively participate in the consultation and decision-making process. LHL patients participating in this study had little experience with SDM in practice, but do prefer it Important barriers for this are healthcare providerrelated (involving patients too little in decision-making, using medical jargon), patient-related (feeling insecure to play a role in decision-making, inability to understand their diagnosis or information about treatment options), patient-provider interaction-related (relationship of trust) or system-related (too little consultation time). The results in secondary care are quite similar and indicate that healthcare providers experience difficulty in applying SDM, especially when communicating with vulnerable patients (e.g., elderly, limited health literate, severely ill patients; Roodbeen et al, 2020; Murugesu et al, 2018; Légaré et al, 2008). Needs of LHL patients concerning SDM in clinical practice, and the kind of support they need to (better) participate in the process of SDM
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