Bart Knottnerus
Publicatie
Datum
25-07-2025
Values clarification as part of shared decision-making with patients with limited health literacy in general practice.
Vriese, L., Jansen, J., Knottnerus, B., Rademakers, J., Weijden, T. van der Values clarification as part of shared decision-making with patients with limited health literacy in general practice. Health Literarcy and Communcation Open: 2025. 3(1), art. nr.2533777.
Lees online
Background
One-third of the Dutch population has limited health literacy (lhl), making it difficult for them to access, understand, appraise, and apply health information. Patients with lhl often adopt a more passive role in shared decision-making (sDM), relying on their doctor to make decisions. a key element of sDM is values clarification:understanding what matters to the patient including their values, preferences, andcircumstances. Values clarification remains under-implemented in healthcare settings, despite its relevance to patients with lhl.
Aims
This study aimed to explore sDM in general practice consultations, focusing onvalues clarification, as observed by researchers and perceived by general practitioners (GPs) and patients with lhl and multimorbidity.
Methods
We video-recorded consultations between 20 GPs and 55 patients with lhland multimorbidity. subsequently, GPs and patients independently rated perceiveds DM using sDM-Q-9. We used OPtiON5 to quantitatively measure observed sDM. We qualitatively analyzed how and when values clarification occurred during consultations.
Results
The observed average sDM performance (OPtiON5, range 0–100) was 10.6 (sD 8.2). GPs rated their sDM performance at 64.7, while patients rated it at 88.9 (sDM-Q-9, range0–100). Qualitative analysis showed that values clarification was about multiple types of preferences, goals, and concerns. GPs typically initiated values clarification by proposing atreatment option and checking if the patient agreed, rather than deliberating collaboratively. This sample of patients with lhl rarely initiated values clarification, but if they did, it mostlyoccurred early in the consultation when they shared their reason for encounter.
Discussion
Observed sDM was low. We saw discrepancies between observed and experienced sDM, possibly due to the difference in how instruments measure sDM, orclinicians overestimating their sDM behavior. Patients reported even higher sDM levels than GPs, suggesting differing understandings or social desirability. Shared understanding of the problem seems an important requirement for values clarification. Values clarification was mainly initiated by GPs, but often resembling a paternalistic approach.asking more open-ended questions may improve values clarification. Future researchinto perspectives and needs of GPs and patients with lhl could improve values clarification and sDM in general practice.
One-third of the Dutch population has limited health literacy (lhl), making it difficult for them to access, understand, appraise, and apply health information. Patients with lhl often adopt a more passive role in shared decision-making (sDM), relying on their doctor to make decisions. a key element of sDM is values clarification:understanding what matters to the patient including their values, preferences, andcircumstances. Values clarification remains under-implemented in healthcare settings, despite its relevance to patients with lhl.
Aims
This study aimed to explore sDM in general practice consultations, focusing onvalues clarification, as observed by researchers and perceived by general practitioners (GPs) and patients with lhl and multimorbidity.
Methods
We video-recorded consultations between 20 GPs and 55 patients with lhland multimorbidity. subsequently, GPs and patients independently rated perceiveds DM using sDM-Q-9. We used OPtiON5 to quantitatively measure observed sDM. We qualitatively analyzed how and when values clarification occurred during consultations.
Results
The observed average sDM performance (OPtiON5, range 0–100) was 10.6 (sD 8.2). GPs rated their sDM performance at 64.7, while patients rated it at 88.9 (sDM-Q-9, range0–100). Qualitative analysis showed that values clarification was about multiple types of preferences, goals, and concerns. GPs typically initiated values clarification by proposing atreatment option and checking if the patient agreed, rather than deliberating collaboratively. This sample of patients with lhl rarely initiated values clarification, but if they did, it mostlyoccurred early in the consultation when they shared their reason for encounter.
Discussion
Observed sDM was low. We saw discrepancies between observed and experienced sDM, possibly due to the difference in how instruments measure sDM, orclinicians overestimating their sDM behavior. Patients reported even higher sDM levels than GPs, suggesting differing understandings or social desirability. Shared understanding of the problem seems an important requirement for values clarification. Values clarification was mainly initiated by GPs, but often resembling a paternalistic approach.asking more open-ended questions may improve values clarification. Future researchinto perspectives and needs of GPs and patients with lhl could improve values clarification and sDM in general practice.
Background
One-third of the Dutch population has limited health literacy (lhl), making it difficult for them to access, understand, appraise, and apply health information. Patients with lhl often adopt a more passive role in shared decision-making (sDM), relying on their doctor to make decisions. a key element of sDM is values clarification:understanding what matters to the patient including their values, preferences, andcircumstances. Values clarification remains under-implemented in healthcare settings, despite its relevance to patients with lhl.
Aims
This study aimed to explore sDM in general practice consultations, focusing onvalues clarification, as observed by researchers and perceived by general practitioners (GPs) and patients with lhl and multimorbidity.
Methods
We video-recorded consultations between 20 GPs and 55 patients with lhland multimorbidity. subsequently, GPs and patients independently rated perceiveds DM using sDM-Q-9. We used OPtiON5 to quantitatively measure observed sDM. We qualitatively analyzed how and when values clarification occurred during consultations.
Results
The observed average sDM performance (OPtiON5, range 0–100) was 10.6 (sD 8.2). GPs rated their sDM performance at 64.7, while patients rated it at 88.9 (sDM-Q-9, range0–100). Qualitative analysis showed that values clarification was about multiple types of preferences, goals, and concerns. GPs typically initiated values clarification by proposing atreatment option and checking if the patient agreed, rather than deliberating collaboratively. This sample of patients with lhl rarely initiated values clarification, but if they did, it mostlyoccurred early in the consultation when they shared their reason for encounter.
Discussion
Observed sDM was low. We saw discrepancies between observed and experienced sDM, possibly due to the difference in how instruments measure sDM, orclinicians overestimating their sDM behavior. Patients reported even higher sDM levels than GPs, suggesting differing understandings or social desirability. Shared understanding of the problem seems an important requirement for values clarification. Values clarification was mainly initiated by GPs, but often resembling a paternalistic approach.asking more open-ended questions may improve values clarification. Future researchinto perspectives and needs of GPs and patients with lhl could improve values clarification and sDM in general practice.
One-third of the Dutch population has limited health literacy (lhl), making it difficult for them to access, understand, appraise, and apply health information. Patients with lhl often adopt a more passive role in shared decision-making (sDM), relying on their doctor to make decisions. a key element of sDM is values clarification:understanding what matters to the patient including their values, preferences, andcircumstances. Values clarification remains under-implemented in healthcare settings, despite its relevance to patients with lhl.
Aims
This study aimed to explore sDM in general practice consultations, focusing onvalues clarification, as observed by researchers and perceived by general practitioners (GPs) and patients with lhl and multimorbidity.
Methods
We video-recorded consultations between 20 GPs and 55 patients with lhland multimorbidity. subsequently, GPs and patients independently rated perceiveds DM using sDM-Q-9. We used OPtiON5 to quantitatively measure observed sDM. We qualitatively analyzed how and when values clarification occurred during consultations.
Results
The observed average sDM performance (OPtiON5, range 0–100) was 10.6 (sD 8.2). GPs rated their sDM performance at 64.7, while patients rated it at 88.9 (sDM-Q-9, range0–100). Qualitative analysis showed that values clarification was about multiple types of preferences, goals, and concerns. GPs typically initiated values clarification by proposing atreatment option and checking if the patient agreed, rather than deliberating collaboratively. This sample of patients with lhl rarely initiated values clarification, but if they did, it mostlyoccurred early in the consultation when they shared their reason for encounter.
Discussion
Observed sDM was low. We saw discrepancies between observed and experienced sDM, possibly due to the difference in how instruments measure sDM, orclinicians overestimating their sDM behavior. Patients reported even higher sDM levels than GPs, suggesting differing understandings or social desirability. Shared understanding of the problem seems an important requirement for values clarification. Values clarification was mainly initiated by GPs, but often resembling a paternalistic approach.asking more open-ended questions may improve values clarification. Future researchinto perspectives and needs of GPs and patients with lhl could improve values clarification and sDM in general practice.
