Health literacy and decision making styles for complex antithrombotic therapy among older multimorbid adults

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.

Consecutive older adults with cardiovascular disease receiving complex antithrombotic therapy completed a comprehensive assessment including measures of FHL and preferences for shared decision making.

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".

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.

We propose an algorithm for screening FHL and preferences for participating in decisions about complex medication regimens.