# Shared decision-making with patients with limited health literacy – experiences and needs of GPs regarding values clarification

## TL;DR

This study explores how general practitioners experience and approach values clarification during shared decision-making with patients who have limited health literacy.

## Contribution

The study provides new insights into GPs' experiences and needs for integrating values clarification with patients with limited health literacy.

## Key findings

- GPs find values clarification important but challenging, especially when intertwined with problem analysis.
- Trust and continuity of care are essential for effective values clarification with patients with limited health literacy.
- GPs need training and strategies to explore patient expectations and manage conflicting clinical guidelines.

## Abstract

Values clarification, a key but under-implemented component of shared decision-making (SDM), involves identifying what matters to a patient relevant to a health decision. It is especially important for patients with limited health literacy (LHL), who often struggle to express preferences. General practitioners (GPs) play a central role in facilitating this process, yet their experiences are underexplored.

To explore how GPs experience values clarification with patients with LHL, the challenges they face, and which support or strategies they consider helpful to better integrate values clarification into decision-making.

We conducted semi-structured interviews with 15 GPs purposively selected from practices in lower socioeconomic areas. Interviews were audio-recorded, transcribed verbatim, and analyzed using the framework method.

Four themes emerged: GPs consider values clarification important but challenging; it goes hand in hand with problem analysis; trust and continuity of care are 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 strong expectations that can conflict with clinical guidelines. GPs expressed needs for training, prompts or scripts, and strategies to explore expectations before consultations.

Values clarification in the context of SDM with patients with LHL is complex and context dependent. Given their ongoing relationships with patients, GPs are well-positioned to facilitate this. GPs’ experiences indicate that values clarification may occur throughout the consultation - often intertwined with problem analysis - reflecting the dynamic nature of SDM in general practice.