Bart Knottnerus
Publicatie
Datum
12-11-2025
Shared decision-making with patients with limited health literacy - experiences and needs of GPs regarding values clarification.
Vriese, L., Knottnerus, B., Groenveld, N., Rademakers, J., Weijden, T. van der, Jansen, J. Shared decision-making with patients with limited health literacy - experiences and needs of GPs regarding values clarification. Scandinavian Journal of Primary Health Care: 2026. 44(1), 17 p.
Lees online
Introduction
Values clarification, a key but under-implemented component of shareddecision-making (sDM), involves identifying what matters to a patient relevant to ahealth decision. it is especially important for patients with limited health literacy (lhl),who often struggle to express preferences. General practitioners (GPs) play a centralrole in facilitating this process, yet their experiences are underexplored.
Aim
to explore how GPs experience values clarification with patients with lhl, thechallenges they face, and which support or strategies they consider helpful to betterintegrate values clarification into decision-making.
Methods
We conducted semi-structured interviews with 15 GPs purposively selectedfrom practices in lower socioeconomic areas. interviews were audio-recorded, transcribedverbatim, and analyzed using the framework method.
Results
Four themes emerged: GPs consider values clarification important butchallenging; it goes hand in hand with problem analysis; trust and continuity of careare essential foundations; and relatives can support and hinder the process. GPs described two contrasting situations: patients with lhl adopting a passive role,prompting a more paternalistic approach, and patients with lhl with strongexpectations that can conflict with clinical guidelines. GPs expressed needs for training,prompts or scripts, and strategies to explore expectations before consultations.
Conclusion
Values clarification in the context of sDM with patients with lhl is complexand context dependent. Given their ongoing relationships with patients, GPs arewell-positioned to facilitate this. GPs’ experiences indicate that values clarification mayoccur throughout the consultation - often intertwined with problem analysis - reflectingthe dynamic nature of SDM in general practice.
Values clarification, a key but under-implemented component of shareddecision-making (sDM), involves identifying what matters to a patient relevant to ahealth decision. it is especially important for patients with limited health literacy (lhl),who often struggle to express preferences. General practitioners (GPs) play a centralrole in facilitating this process, yet their experiences are underexplored.
Aim
to explore how GPs experience values clarification with patients with lhl, thechallenges they face, and which support or strategies they consider helpful to betterintegrate values clarification into decision-making.
Methods
We conducted semi-structured interviews with 15 GPs purposively selectedfrom practices in lower socioeconomic areas. interviews were audio-recorded, transcribedverbatim, and analyzed using the framework method.
Results
Four themes emerged: GPs consider values clarification important butchallenging; it goes hand in hand with problem analysis; trust and continuity of careare essential foundations; and relatives can support and hinder the process. GPs described two contrasting situations: patients with lhl adopting a passive role,prompting a more paternalistic approach, and patients with lhl with strongexpectations that can conflict with clinical guidelines. GPs expressed needs for training,prompts or scripts, and strategies to explore expectations before consultations.
Conclusion
Values clarification in the context of sDM with patients with lhl is complexand context dependent. Given their ongoing relationships with patients, GPs arewell-positioned to facilitate this. GPs’ experiences indicate that values clarification mayoccur throughout the consultation - often intertwined with problem analysis - reflectingthe dynamic nature of SDM in general practice.
Values clarification, a key but under-implemented component of shareddecision-making (sDM), involves identifying what matters to a patient relevant to ahealth decision. it is especially important for patients with limited health literacy (lhl),who often struggle to express preferences. General practitioners (GPs) play a centralrole in facilitating this process, yet their experiences are underexplored.
Aim
to explore how GPs experience values clarification with patients with lhl, thechallenges they face, and which support or strategies they consider helpful to betterintegrate values clarification into decision-making.
Methods
We conducted semi-structured interviews with 15 GPs purposively selectedfrom practices in lower socioeconomic areas. interviews were audio-recorded, transcribedverbatim, and analyzed using the framework method.
Results
Four themes emerged: GPs consider values clarification important butchallenging; it goes hand in hand with problem analysis; trust and continuity of careare essential foundations; and relatives can support and hinder the process. GPs described two contrasting situations: patients with lhl adopting a passive role,prompting a more paternalistic approach, and patients with lhl with strongexpectations that can conflict with clinical guidelines. GPs expressed needs for training,prompts or scripts, and strategies to explore expectations before consultations.
Conclusion
Values clarification in the context of sDM with patients with lhl is complexand context dependent. Given their ongoing relationships with patients, GPs arewell-positioned to facilitate this. GPs’ experiences indicate that values clarification mayoccur throughout the consultation - often intertwined with problem analysis - reflectingthe dynamic nature of SDM in general practice.
Aim
to explore how GPs experience values clarification with patients with lhl, thechallenges they face, and which support or strategies they consider helpful to betterintegrate values clarification into decision-making.
Methods
We conducted semi-structured interviews with 15 GPs purposively selectedfrom practices in lower socioeconomic areas. interviews were audio-recorded, transcribedverbatim, and analyzed using the framework method.
Results
Four themes emerged: GPs consider values clarification important butchallenging; it goes hand in hand with problem analysis; trust and continuity of careare essential foundations; and relatives can support and hinder the process. GPs described two contrasting situations: patients with lhl adopting a passive role,prompting a more paternalistic approach, and patients with lhl with strongexpectations that can conflict with clinical guidelines. GPs expressed needs for training,prompts or scripts, and strategies to explore expectations before consultations.
Conclusion
Values clarification in the context of sDM with patients with lhl is complexand context dependent. Given their ongoing relationships with patients, GPs arewell-positioned to facilitate this. GPs’ experiences indicate that values clarification mayoccur throughout the consultation - often intertwined with problem analysis - reflectingthe dynamic nature of SDM in general practice.
