Understanding health literacy barriers to improve shared decision making when optimizing medications involving complex therapeutic regimes

The management of people experiencing multimorbidity (more than two long-term diseases) and polypharmacy (more than 5 regular medicines) presents a multi-disciplinary, multi-organisation and multi-stakeholder challenge.

Potentially inappropriate medications (PIMs) are those where the potential risks associated with use outweigh the potential benefits; 20-60% of elderly patients are taking at least one PIM. Deprescribing, the process of withdrawal of an inappropriate medication, has been proposed as an intervention to reduce the harm associated with inappropriate polypharmacy. Both prescribers and patients need to be supported to make an informed decision about the benefits and risks of continuing medications in the absence of an evidence base that is representative of a complex multimorbid state.

There are several barriers to shared decision making such as lack of time, scarce trustworthy information and the attitude of clinicians. From the patient’s perspective, limited health literacy (LHL) has been reported as a significant barrier to clear communication and appropriate decision making. LHL and low numeracy have been associated with a range of adverse health effects, including worse self‐management skills; poor adherence to medication; greater risk of hospitalization, emergency care visits and lack of preventative care; worse health status; and lower quality of life. Systematic review of patient education materials available to aid deprescribing revealed that most are pitched above average reading levels making them inaccessible for LHL populations. Furthermore, the advent of incorporating genomic information into prescribing decisions adds a further layer of complexity when communicating uncertainty and complexity around prescribing.

This project aims to engage relevant stakeholders including patients, their carergivers and prescribers (both primary and secondary care setting) to assess i) attitudes towards medicines optimisation and genomic information ii) accessibility of patient education materials and iii) development of education materials for deprescribing and genomic information that specifically target those with LHL and low numeracy.

This project will:
1. Use the All Aspects of Health Literacy Scale (AAHLS) to measure functional, communicative and critical health literacy to interpret the readability of currently available patient education materials for both deprescribing and genomic prescribing information in those with LHL and low numeracy.
2. Assess patient, caregiver and prescriber attitudes towards and understanding of medicines optimisation and genomic information
Develop accessible and understandable patient education materials specifically designed for those with LHL and low numeracy and assess their userability through a National network of deprescribing clinics.

It is expected the successful applicant (s) must commence on or before 1st February 2021.

For any enquiries please contact Dr Lauren Walker on [Email Address Removed]

If you wish to apply, please send a covering letter, full CV together with names and contact details of two academic referees, stating the research proposal/s of interest to you and why you think you are suitable. Please send to Dr Lauren Walker on [Email Address Removed] and Professor A Alfirevic on [Email Address Removed]