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Naik AD, Street RL, Castillo D, Abraham NS. Health literacy and decision making styles for complex antithrombotic therapy among older multimorbid adults. Patient education and counseling. 2011 Dec 1; 85(3):499-504.
OBJECTIVES: To evaluate the effect of functional health literacy (FHL) on preferences for decision-making; and among those initially preferring a passive decision-making role, to explore how preferences change if their physician actively encourages their involvement. METHODS: Consecutive older adults with cardiovascular disease receiving complex antithrombotic therapy completed a comprehensive assessment including measures of FHL and preferences for shared decision making. RESULTS: Half of all participants had inadequate or marginal FHL. Those with inadequate FHL were more likely (P = 0.01) to prefer passive rather than active decision making styles even after controlling for age, education, and numeracy. However, 40% of patients preferring passive styles had adequate FHL and these patients were significantly more likely to change their preference to more active styles (odds ratio = 7.17, P < .01) if their physician "was more supportive or encouraged participation". CONCLUSIONS: Screening FHL can provide insight into patients'' preferences for active participation in decision making. Clinicians'' encouragement of participation can increase engagement by patients with adequate FHL. PRACTICE IMPLICATIONS: We propose an algorithm for screening FHL and preferences for participating in decisions about complex medication regimens.