TY - JOUR
T1 - The influence of health literacy, anxiety and education on shared decision making and decisional conflict in older adults, and the mediating role of patient participation
T2 - A video observational study
AU - Pel-Littel, Ruth E.
AU - Buurman, Bianca M.
AU - Minkman, Mirella M.
AU - Scholte op Reimer, Wilma J. M.
AU - Twisk, Jos W. R.
AU - van Weert, Julia C. M.
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024/7/1
Y1 - 2024/7/1
N2 - Objective: To explore the relationship between personal characteristics of older adults with multiple chronic conditions (MCCs) and perceived shared decision making (SDM) resp. decisional conflict. Methods: In a video-observational study (N = 213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data. Results: The mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β.01, p < .001) was significantly associated with participation in the SDM process. Education (β = −2.43, p = .05) and anxiety (β = −.26, p = .058) had a marginally significant direct effect on the patients’ perceived level of SDM. Education (β = 12.12, p = .002), health literacy (β = −.70, p = .005) and anxiety (β = 1.19, p = .004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM. Conclusion: Health literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict. Practice Implications: Tailoring SDM communication to health literacy levels is important for high quality SDM.
AB - Objective: To explore the relationship between personal characteristics of older adults with multiple chronic conditions (MCCs) and perceived shared decision making (SDM) resp. decisional conflict. Methods: In a video-observational study (N = 213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data. Results: The mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β.01, p < .001) was significantly associated with participation in the SDM process. Education (β = −2.43, p = .05) and anxiety (β = −.26, p = .058) had a marginally significant direct effect on the patients’ perceived level of SDM. Education (β = 12.12, p = .002), health literacy (β = −.70, p = .005) and anxiety (β = 1.19, p = .004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM. Conclusion: Health literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict. Practice Implications: Tailoring SDM communication to health literacy levels is important for high quality SDM.
KW - Multiple chronic conditions
KW - Older adults
KW - Patient participation
KW - Personal characteristics
KW - Shared decision making health literacy
UR - http://www.scopus.com/inward/record.url?scp=85189027949&partnerID=8YFLogxK
U2 - 10.1016/j.pec.2024.108274
DO - 10.1016/j.pec.2024.108274
M3 - Article
C2 - 38547640
SN - 0738-3991
VL - 124
JO - Patient Education and Counseling
JF - Patient Education and Counseling
M1 - 108274
ER -