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A three-talk model for shared decision making: multistage consultation process

BMJ 2017; 359 doi: (Published 06 November 2017) Cite this as: BMJ 2017;359:j4891

Health literacy integrates with the three-talk model for shared decision making

Shared decision making is one component of the process reflecting the quality of care. In order to improve the performance of the shared decision making approach, Elwyn and colleagues have proposed an easy-to-remember model depicting the conversational steps, portrayed in a visual format. The model is initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences (Elwyn et al., 2017).

There are several barriers to shared decision making such as lack of time, scarce trustworthy information, the attitude of clinicians. From the patient’s perspective, limited health literacy has been reported as a significant barrier to clear communication and appropriate decision making (Griffey et al., 2016). In the system approach, the health literacy of hospitals is critically important in implementing the shared decision making process (Hernandez, 2012). Health literacy should be integrated into every step of the model, from “team talk”, “option talk”, to “decision talk”. Therefore, simplifying the model, together with increasing the health literacy of patients and hospitals could contribute to improving the effectiveness of the decisions made.

Elwyn, G., Durand, M. A., Song, J., Aarts, J., Barr, P. J., Berger, Z., . . . Van der Weijden, T. (2017). A three-talk model for shared decision making: multistage consultation process. BMJ, 359, j4891. doi:
Griffey, R. T., McNaughton, C. D., McCarthy, D. M., Shelton, E., Castaneda-Guarderas, A., Young-Brinn, A., . . . Grudszen, C. (2016). Shared Decision Making in the Emergency Department among patients with Limited Health Literacy: Beyond Slower and Louder. Academic Emergency Medicine, 23(12), 1403–1409. doi:
Hernandez, L. M. (2012). How Can Health Care Organizations Become More Health Literate?: Workshop Summary. Washington (DC): National Academies Press (US).

Competing interests: No competing interests

08 December 2017
Van Tuyen Duong
Research Fellow
Taipei Medical University
No 250, Wuxing Street, Taipei City, Taiwan, 110