In this concept, we define a group of concepts relating to ‘Shared decision-making’, including ‘Patient decision aid’, ‘Health literacy’, ‘Coaching’ and ‘Patient activation’.

Shared decision-making

In a shared decision, a health care provider communicates to the patient personalized information about the options, outcomes, probabilities, and scientific uncertainties of available treatment options, and the patient communicates his or her values and the relative importance he or she places on benefits and harms.

Source: Wennberg JE (2010) Tracking Medicine. A Researcher’s Quest to Understand Health Care. Oxford University Press.

Example of the term in use:

The skills of shared decision-making are unlikely to be developed, let alone exhibited, unless the clinician agrees with the guiding ethical principles. At its core, shared decision-making rests on accepting that individual self-determination is a desirable goal and that clinicians need to support patients to achieve this goal, wherever feasible.

Elwyn G, Frosch D, Thomson R et al (2012) Shared Decision Making: A Model for Clinical Practice. J Gen Intern Med 2012 Oct; 27(10): 1361–1367. Published online 2012 May 23. doi: 10.1007/s11606-012-2077-6

Health professionals are trained in shared decision-making to ensure that patients are actively involved in their own care when they do require input from health services.

Alderwick H, Ham C, Buck D (2015) Population health systems. Going beyond integrated care. February 2015. The King’s Fund. Page 16.

Patient decision aid

Patient decision aids are … intended to supplement rather than replace patient-practitioner interaction. They may be leaflets, interactive media, or video or audio types. Patients may use them to prepare for talking with a clinician, or a clinician may provide them at the time of the visit to facilitate decision making. At a minimum, patient decision aids provide information about the options and their associated relevant outcomes.

Source: Elwyn G (2006) Developing a quality criteria framework for patient decision aids; online international Delphi Consensus process. British Medical Journal 333: 417-427.

Example of the term in use:

Patient decision aids are a means of helping people make informed choices about healthcare that take into account their personal values and preferences. Decision aids are a part of a shared decision making process, encouraging active participation by patients in healthcare decisions.

Drugs and Therapeutics Bulletin. An introduction to patient decision aids. BMJ 2013; 347 doi: (Published 23 July 2013) Cite this as: BMJ 2013;347:f4147

Health literacy

Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.

Source: World Health Organization. Health Promotion Glossary.

Example of the term in use:

So having defined health literacy we can now begin to consider whether it really matters. The short answer is yes, because recent research in England tells us that between 43% and 61% of English working age adults routinely do not understand health information. This also has a financial cost – 3% to 5% of the annual UK health budget. Compelling though this is I often find that what really grabs people’s attention is the human cost. In many years of practice in this area my colleagues and I have come across lots of real life examples of where limited health literacy has had a really serious impact on people’s life in general, and health and wellbeing in particular.

Berry J. Blog. Does health literacy matter? 19 October 2016.


Coaching develops patients’ skills in preparing for a consultation, deliberating about options, and implementing change. Trained facilitators, who are supportive but do not make decisions for the patient, coach patients before or after an encounter with a clinician. Coaches are often nurses, but they may also be other health professionals or trained patients. Coaching is provided face to face between individuals or groups, or over the telephone, email, or internet. Human interaction is usually involved, but automated coaching using telephone or e-tools is evolving.

Source: O’Connor AM, Stacy D, Legare F (2008) Coaching to support patients in making decisions. BMJ 2008; 336: 228. BMJ 2008; 336 doi: (Published 31 January 2008).

Example of the term in use:

Health Coaching, which is one form of self-management support, is designed to empower patients within the health care setting and in their daily lives. Within the health care setting, empowerment is characterized by voicing concerns, asking questions, providing information about home monitoring, and collaboratively developing care plans. In their daily lives, empowered patients are more likely to adhere to treatment plans and engage in lifestyle changes to effectively manage their chronic conditions.

Willard-Grace R, DeVore D, Chen EH et al (2013) The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidaemia: protocol for a randomized controlled trial and baseline characteristics of the study population. BMC Fam Pract 2013; 14: 27. Published online 2013 Feb 23. doi:  10.1186/1471-2296-14-27

Patient activation

‘Patient activation’ describes the knowledge, skills and confidence a person has in managing their own health and care. Evidence shows that when people are supported to become more activated, they benefit from better health outcomes, improved experiences of care and fewer unplanned care admissions.

Patient activation is of particular importance to the 15 million people living with long-term conditions (LTCs) who rely, more than most, on NHS services. By understanding people’s activation levels, the NHS can support those people with LTCs in ways appropriate to their individual needs.

Source: NHS England. Patient activation. People’s ability to manage their own health and wellbeing.

Example of the term in use:

Since 2004, there have been a number of cross-sectional studies that have found patient activation (usually measured with the PAM) to be related to healthy behaviors (e.g. physical activity, frequency of eating fruits and vegetables), appropriate use of health care system (e.g. having a regular source of care, not delaying care), consumeristic behaviors (e.g. researching physician qualifications, preparing a list of questions for a doctor visit), chronic care self-management (e.g. eye examinations for people with diabetes, keeping diary of blood pressure readings), and control of chronic illness (e.g. HbA1c control, fewer hospitalizations). Many of the studies are limited, however, by reliance upon self-reported health outcomes and use of relatively small samples.

Greene J, Hibbard HJ (2012) Why does patient activation matter? An examination of the relationships between Patient Activation and Health-Related Outcomes. J Gen Intern Med 2012; 27(5): 520-526. Published online 2011 Nov 30. doi:  10.1007/s11606-011-1931-2