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: a video observational study

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.