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

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.