Shared Decision-Making to Improve Health Literacy
Organizations can improve health literacy by focusing on shared decision-making between patients and healthcare
providers. As many health systems move to delivering care that is more patient-centered, there is a need to use
strategies that help the patient understand their role in making medical decisions. Research suggests that
focusing on shared decision-making
strategies may be especially helpful for people with more limited health literacy skills. One promising
approach that rural providers can use for shared decision-making is the SHARE Approach.
The SHARE Approach
Approach was developed by the Agency for Healthcare Research and Quality (AHRQ) to help healthcare
providers and patients engage in more informed shared decision-making. This approach allows healthcare
professionals to engage in meaningful conversations with patients, encourages understanding, and allows patients
to take control of their healthcare decisions by weighing risks and benefits.
The SHARE Approach involves five steps:
Seek participation: Involve the patient in the decision-making process.
Help explore treatment options: Help the patient to understand their treatment options.
Assess values and preferences: Listen and consider patient values, culture, and preferences.
Reach a decision: Come to a decision with the patient.
Evaluate the decision: Weigh the chosen decision and measure whether all evidence-based information was
AHRQ designed the SHARE
Approach Workshop Curriculum for healthcare providers to learn the proper techniques of the approach.
The curriculum includes an introduction and four content modules: 1) Shared Decision-Making and the SHARE
Approach, 2) Using Patient-Centered Outcomes Research (PCOR) in Shared Decision-Making, 3) Communication, 4)
Putting Shared Decision-Making Into Practice, and 5) Trainers' Module.
Examples of Programs Using Shared Decision-Making to Improve Organizational Health Literacy
The Patient-Centered Outcomes Research Institute (PCORI) has funded over 50 research projects involving
shared decision-making, several of which include implementation projects that are studying different
approaches for incorporating these techniques into patient care. Several of these projects have sites that
serve rural communities. For example, one PCORI-funded implementation project is exploring the use of shared
decision-making through the creation of a decision
aid for patients and caregivers deciding whether to use a left ventricular assist device (LVAD) or
medical therapy for heart failure. This project aims to implement this decision aid in as many locations
across the country where patients can receive LVADs.
research project focused on the use of shared decision-making to train staff in 30 different
doctor's offices in North Carolina to help patients when choosing treatment options for asthma. This project
included several implementation sites in rural counties. Patients who participated at sites where the staff
received the longer training program expressed more confidence in choosing their asthma treatment options.
Madison University Student Health Center used the SHARE Approach to engage patients in a shared
decision-making project to reduce demands for inappropriate use of antibiotics, with the overall goal of
decreasing risk of antibiotic resistance. Using guidance from an AHRQ SHARE Approach train-the-trainer
workshop, the associate director of the center became certified as a master trainer in the SHARE Approach.
She then trained health center staff on the approach so staff could educate students visiting the health
center about proper antibiotic use.
Rural communities can especially benefit from this approach given the long-term trust relationships that many
rural patients have with their providers. Building on this trust and focusing on decision-making can improve
patient treatment and overall health outcomes. AHRQ has
developed many additional resources and tools to help healthcare organizations who want to use the SHARE
Approach to improve patient-provider communication and focus on improving organizational health literacy. These
resources include implementation considerations as well as implementation steps for designing programs that use
the approach. Successful implementation stories are also included.
Resources to Learn More
Perceptions of Shared Decision Making and
Decision Aids Among Rural Primary Care Clinicians
Examines the awareness and application of Shared Decision Making (SDM) and Decision Aids (DAs) by primary care
clinicians when helping patients in rural settings make decisions about their health condition.
Author(s): King, V., Davis, M., Gorman, P., & Fagnan, L.J.
Citation: Medical Decision Making, 32(4), 636-644
Offers accredited webinars and resources supporting the integration of shared decision-making concepts in a
variety of healthcare settings, including rural. Resources discuss the SHARE Approach (a five-step process) and
the benefits to both the healthcare professional and the patient.
Organization(s): Agency for Healthcare Research and Quality (AHRQ)