Addressing health literacy in patient decision aids

Abstract

BackgroundEffective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess:1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations.MethodsWe reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews.ResultsAim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed.ConclusionLower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients.

Impact of Sociodemographic Patient Characteristics on the Efficacy of Decision Aids

“…The consistent improvement in general knowledge with the DAs across varying levels of education suggests that the DA use during the clinical encounters might help address disparities attributable to inadequate health literacy; the need for a focus on patients with lower health literacy, and the potential effectiveness of DAs in this population, is described in the DA literature. 25 There was a significant interaction between education level and treatment arm in the outcome of knowledge of risk, suggesting that DA may be more efficacious among patients with higher levels of education with certain types of information, such as communication of specific risk values. Still, with a significant impact in knowledge transfer regardless across varying education levels, DA may be a potential tool to address differences in health literacy that may be linked to poor health outcomes.…”

Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform

“…preferences for different levels of information and decision support [2][3][4][5][6][7][8][9][10]. For example, when patients are using a decision aid, particularly delivered online, to deliberate about a tough health care decision, do monitoring and blunting coping styles persist for both information seeking and the level of engagement in active deliberation?…”

Developing a Taxonomy and Mapping Concepts of Shared Decision Making to Improve Clinicians Understanding

“…56 While there has been over 500 decision aids developed, 4 evidence suggests routine use is low 57 and few address the needs of lower health literacy. 58 The quality of decision aids vary, rapidly outdate as new treatments become available and may not be readily accessible or available. 55 While decision aids may offer hope of simplifying SDM, more research is required to determine the benefits of decision aids in shared decision making.…”