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Lesson3:SharedDecisionMaking

LearningObjectives
x Encourageactiveparticipationbythepatientindecisionmakingandexplainchoicesor
rightstothepatientinapatientcenteredmanner
x Assesspatientdesireandcapacitytobeinvolvedandresponsibleinthedecisionmaking
process
x Determinepatientpreferencesandprioritiesfortreatment
x Identifystrategiestoassistpatientsindiscussingpreferencesandprioritieswithclinician
x Supportthepatientinthedecisionmakingprocessinalignmentwithdesiredlevelof
engagement
x Describeatreatmentplan
x Assessbarrierstopatientadherencetotheplan
x Developaplanwiththepatientforaddressingadherencechallenges
x Identifyselfmanagementandhealthpromotionresources
KeyTakeaways
x Patientparticipationindecisionmakingcanimprovepatientknowledge,adherenceto
treatmentandoutcomes.Evenamongpatientswhodonotwishtoactivelyparticipate
indecisionmaking,havinganinteractivediscussionwiththeirproviderimprovespatient
satisfactionwithcare.
x Healthliteracy,language,physicalconditionandenvironmentandlearningstyleimpact
apatientscapacityfordecisionmakingresponsibility.
x Patientnavigatorsshouldsupportpatientsinthedecisionmakingprocess.
x Patientsmayfacechallengesadheringtotheirtreatmentplan.Cliniciansshouldalways
bemadeawareofadherencechallenges.
x Patientscanhelpselfmanagetheirdisease,andpatientnavigatorscanprovidesupport
topatients.However,patientnavigatorsshouldneverprovideclinicalinformationto
patients.
 

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 LESSON3:SHAREDDECISIONMAKING


SharedDecisionMaking
 EngagementBehaviorFramework
UnderstandingHealthLiteracy
 HealthLiteracyChecklist
SummaryofLearningStyles
 TreatmentPlanandAdherence
SelfManagement
 SelfManagementResourcesforPatients
CancerOrganizations
 ResourcesforPatientNavigators
ResourcesforPatients








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SharedD
DecisionMaking

Certaine
elementsmu
ustbeinplaccetoencourragepatient sactiveparrticipationin
ncare.Thesee
include:

x PatientKnow wledge
x PhysicianEnccouragement
x Beliefinrightt/responsibillitytoparticcipate
x Awarenessof
A fchoice
x Timewithphysician

Patientn ngusingthe
navigatorscaanencouragepatientpaarticipationi nshareddecisionmakin
followingggeneralpattientcenterredstrategie es:

Encourageth
hepatientan
ndbuildapaartnership

Settheagend
datogether

Practiceactiv
P velistening

Ensurethepaatientunderrstandsinforrmation

Displaywarm
D mthandemp
pathyverballlyandnonvverbally

navigatorscaanusedifferrentapproacchestohelppatientsind
Patientn discussingtrreatment
preferencesandprioorities.Theggoalistomakesurepati entsundersstandandhaavetheir
questionsanswered..Thepatienttnavigatorffacilitatesth isprocessraatherthananswering
questionsormakingrecommend dations.

x Understandw
U whatpatienttsneedtom makeinformeeddecisionss
x Coordinatewwithclinicians
x Usedecision
U aidsandtailloredinform
mation
x Communicate eeffectivelyy
x Returntothe
e5As(Ask,AAssess,Advisse,Assist,Arrrange)



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Hereare somequesttionsanaviggatormightaasktostartaaconversationwithapaatientaboutt
preferences.Theseq questionscanhelpyoub
betterunderrstandthepaatientsneedsandadvo ocate
ontheirb
behalfifneccessary.

x Doyouhave
D anyreligioussbeliefs?Ifso,howdo thoseimpacctyourcare??
x Whatabouts
W spiritualbeliefs?
x Howdoyoul
H iketolearnnewinformation?(Giveeexampleso ofvisual,aud
ditoryandkiinetic
le
earningstyle
es)
x Howmuchin
H formationwwouldyoulikketohaveabboutyourpaarticulardiseeaseor
trreatment?
x Whatistheb
W bestwaytoccommunicattewithyou? 
x Issthereanyoneelseyouwouldliketobeinvolveedinyourcaare,likeafrieend,family
memberorre
m eligious/spirritualadvisorr?
x Whatdoyou
W dototakeccareofyoursself?Howcaanourteam
msupportyo ouintakingccare
ofyourself?


Considerrationsinasssessingcapaacityforsharreddecision makingsho
ouldinclude::

Physiccalcondition
Language
andeenvironment

Heaalthliteracy Leearningstyle
Caapacityfor
Decision
making
Responsibility


Sources:Fraenkeletal.2007;Ep
psteinetal.2
2007;U.S.D epartmento ofHealthandHuman
Services.ImprovetheUsabilityo ormation.n .d.;NielsenBohlmanetal.2004;
ofHealthInfo
Beagley.2011;Kutneeretal.2006
6;Beagley.22011.

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Engagem
mentBehavio
orFramewo
ork

TheEngaagementBehhaviorFrame eworkwasccreatedtodeescribetheb
behaviorsin
ndividualscan
taketob
beengagedintheirhealtthcare.

Findgoodhealthcare

Co
ommunicatew
withhealthcareprofessio
onals

Organizehealthcare

Paayforhealthcare

Makegoodtre
M atmentdecissions

Paarticipateintreatment

Prromotehealth
h

Ge
etpreventive
ehealthcare

Planforendofflife

Se
eekhealthknowledge




Learnmo
oreabouttheEngageme
entBehaviorrFrameworkk. 

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Understa
andingHealtthLiteracy

Literacy,healthliteraacyandlimittedEnglishp
proficiencyaarerelated,b
butdifferent,concepts.
Theyaredistinguishe edbelow:

LimitedEngglish
LowLiteracy
L y LowHeallthLiteracy
Proficien
ncy

Cannotreadorw write, Havediffiicultieswith h Maybeliterattein

so: reading,w writing, theirprimary
Setrealistic speakingor lannguagebutstruggle
obje ectives. computin ngtosolve tocommunicaatein
Foccusonbehavviors problems,so: Ennglish,so:
anddskills. Spendm moretime A Arrangeinteerpretor
Presentthecon ntext makingsurethey sservices
firstt,thengiven
new understand.
info
ormation. Adaptyo our
Breakupinto interactionstyleto
smaallerparts. betterfiittheir
ability,fforexample
Makeeducation nal
youcouldpause
sesssionsinteracctive.
moreofftentoask
thepatienttotell
youwhaatthey
heard.
Selectm more
approprriate
resourceesthatare
tailoredtotheir
ability.

Source:EEuroMedInfo
o.DesigningLowLiteraccyMaterials..n.d.

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HealthLiteracyChecklist:LowLiteracy

MAKESEXCUSESNOTTOREADONTHESPOT

POINTSTOTEXTWHILEREADING

EYESDON'TFINDACENTRALFOCUS

IDENTIFIESMEDICATIONSBYSIZE,COLORORSHAPE

GIVESINCORRECTANSWERSWHENASKEDABOUTWHATTHEYHAVEREAD

INCOMPLETEORPOORLYCOMPLETEDPAPERWORK


HealthLiteracyChecklist:
DifficultyComprehendingHealthInformation

HASDIFFICULTYWITHABSTRACTCONCEPTS

POORMEDICATIONADHERENCE

MISSEDAPPOINTMENTS

NERVOUSNESS,CONFUSION,FRUSTRATIONORINDIFFERENCEINCOMPLEX
LEARNINGSITUATIONS

PROVIDESINCOMPLETEMEDICALINFORMATION

WITHDRAWSWHENCOMPLEXINFORMATIONISPRESENTED


Source:Cornette,2009.



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Toassesshealthliteracy,tryaskingthesequestions:
Howhappyareyouwiththewayyouread?
Whenyouhavetolearnsomething,howdoyouprefertolearntheinformation?
Howoftendoyouhaveproblemslearningaboutyourmedicalconditionbecauseof
difficultyunderstandingwritteninformation?
Howconfidentareyouinfillingoutmedicalformsbyyourself?

Ifyoucanonlyaskonequestion,askingabouthowconfidentthepatientisfillingoutinformationby
himselforherself.

Toaddresstheseissuesyoumayneedto:
Offertohelppatientswithcompletingformsanddothisconfidentiallyandprivately
Simplifyandclarifyinstructions
Spendmoretimemakingsurethepatientunderstands
Havethepatientrepeatinformationbacktoyou
Adaptyourinteractionstyletobetterfittheirability(forexamplepausemoreoftento
askthepatienttorepeatwhattheyheard)
Selectmoreappropriateresourcesthataretailoredtotheirliteracyabilities
Usevisualaidsandprovidemapstoreferralsites

Usingplainlanguageasastrategycanbeeffectiveinaddressinglowhealthliteracy.
Communicatinginplainlanguagemeansthattheindividualwillunderstandwhattheyhearor
readthefirsttime.Hereisastrategyforprovidinginformationinplainlanguage.
Organizethelanguagewiththemostimportantinformationpresentedfirst
Dividethemessagesintochunkstomakemorecomplexinformationeasierto
understand
Speakorwriteusingsimplewordsandprovidedefinitionsofanytechnicalterms
Useactivevoice

LoworlimitedliteracyisnotthesameaslimitedEnglishproficiency(LEP).IndividualswithLEP
maybeliterateintheirprimarylanguagebutstruggletocommunicateinEnglish.Inthese
instances,translationservicesarenecessary.

Sources:Cornett.2009;U.S.DepartmentofHealthandHumanServices.HealthLiteracyBasics.
n.d. 

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SummaryyofLearningStyles

Patientnnavigatorscaanassesstheeirpatientslearningstyyletodeterm
minethebesstmethodfo or
sharinginnformation.Itisimportaanttoremem mberthatleearningstyleesarenotweeaknessesbut
justpersonalprefereencesforinfoormation.Yo ourpatientmmayhavemmorethanon nelearningstyle,
inwhichcasepresen ntinginformaationinmorrethanonefformatmaybemostefffective.The
FlemingaandMillsVAARKlearningtheorydesccribesthestyylesoflearn ning,Visual,Auditory,Reead
orWriteandKinesth hetic,astheyyrelatetopaatienteducaation.

Pictures,charts,videos Verrbalinformatio
on

Visual Auditoryy

WritttenWords Haandsonlearninng

ReadorWrite
R Kinestheetic



Strategie osupportpattients:
esthatpatientnavigatorrscanuseto
x Provideinformationinauserfriendlyyway
x Provideverbaalsupportoffpatientsabilitytomakkedecisions
x Understandp
U patientsdeccisionsandp
preferencesmaychangee
x Faacilitateope
endialogueb betweenthe ntifiesgoalsthat
epatientanddthephysiccianthatiden
areimportanttopatientss
x Provideongo oingsupportandencouragement
x Refertocommunitybase edorganizationsandenccouragepattientstousethem

Sources:Beagley.2011;Inottetal.2011;Fle neCommittee
emingetal.nn.d.;InstitutteofMedicin
onHealth
hLiteracy.H
HealthLiteracy:APrescriptiontoEnddConfusion .2004;McC Corkleetal.2
2011.

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TreatmentPlansandAdherence

 TreatmentPlan:Adocumentthatdescribesthepathofcancercare,andcanbegiventothe


patient,familyorothermembersofthecareteaminordertoinformeveryoneaboutthe
pathofcareandwhoisresponsibleforeachportionofthatcare


Atreatmentplanincludes:

Specifictissuediagnosis Expectedcommonandrare
Initialtreatmentplanand
andstage,including toxicitiesduringtreatment
proposedduration
relevantbiomarkers andtheirmanagement

Whowilltakeresponsibility
Expectedlongtermeffects forspecificaspectsof Psychosocialand
oftreatment treatmentandtheirside supportivecareplans
effects

Vocational,disability,or
Advancecaredirectives
financialconcernsandtheir
andpreferences
management


Patientsmayhavetroublefollowingtheirtreatmentplan.Forexample,theymay:

x Failtofillprescriptionsbecausethey
o Feelthatthemedicationisntnecessary
o Areunabletoaffordthemedication
o Donotwanttotakethemedication
o Donotbelievethemedicationwillbeeffective
x Notwanttochangetheirbehavior
x Wanttoavoidthesideeffectsoftreatment
x Havedisbeliefabouttheseverityoftheircondition
x Feeltoobusyortoostressedtofollowthetreatmentplan
x Feelincapableofchangingtheirbehavior
x Beuninvolvedintreatmentplancreation


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Regardlessofthechallenge,therearestepsthatcanbetakentoaddressbarriersandhelp
patientsadheretotheirtreatmentplan.Alwaysmakesurethedoctorisawareofany
adherenceissues.

Benonjudg
mentalwhen
Followup followingup
with on
Havethe questions
patient treatment
Helpthe summarize plan
patient whatwas adherence
Talktothe choosethe
patient just
Determine optionthat discussed
abouttheir makesthe
the options
Agreeon appropriate mostsense
whatthe goalto tothem
patients overcome
challengeis the
totreatment challenge
adherence




Sources:Baloghetal.2011;Lowes.1998;Butterworth.2008.

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SelfMan
nagement

Apartoffadheringto
othetreatmentplanme
eansencouraagingpatientstoselfmaanagetheirccare.
Selfmannagementistakingtheactionsnecesssarytolivewellandmaanagechronicconditions.
Patientscomfortable ewithselfm
managementtcoordinate thevariousaspectsofttheircare.Seelf
managem mentincludees:

Tracking
T
syymptoms

Determ
mining
Schedulin ng
whattodo
doctors
whhen
appoint
Typ
picalSelff symptoms
mentsan nd
cau
use
labvisits Man
nagemen nt problems
Tasks

Taking A
Adopting
meedications
as
healthy
prescribed b
behaviors

Sources:Adamsetall.2004;Pearrsonetal.20
007.


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SelfManagementResourcesforPatients

SelfManagement Examples(Resources,Tools,Organizations,Services,
Resources Programs,MobileApps)
Exercise LIVESTRONGattheYMCA,AmericanCancerSocietyNutrition
andPhysicalActivityDuringandAfterCancerTreatment:
AnswerstoCommonQuestions,MDAndersonCancerCenter
NutritionandExerciseforCancerSurvivors

Generalfitnesstrackers/apps:SuperTracker,MyFitnessPal,
Runkeeper,Moves,Fitocracy

Coping CancerSupportCommunity,CancerCare,CancerHope
Network

Stress MindfulnessBasedStressReductionInformation,Relaxation
Management TechniquesforHealth:WhatYouNeedtoKnow
QuittingTobacco Smokefree.gov,AmericanLungAssociation:GettingHelpto
Consumption QuitSmoking,AmericanCancerSociety:GuidetoQuitting
Smoking(alsoavailableinSpanish)

HealthCareTeam Providecontactinformationforrelevanthealthcareteam
membersforpatients.Forexample,contactinformationfor
 themedicaloncologist,surgeon,radiationoncologistandwhat
numbertocallforafterhoursconcerns

HospitalFacility/ Provideinformationonsupportgroupsandotherresourcesat
Resources yourfacilitysuchaschaplaincyservices,painmanagement,
physicaltherapy/rehabilitation,palliativecare,exerciseclasses
 anddietitianservices

Community Provideinformationonlocalresourcesrelevanttopatients
Resources suchaslocalchaptersofnationalorganizations(suchasSisters
NetworkInc.,AmericanCancerSociety,CancerSupport
 Community),communitysupportgroups,cookingclasses,local
organizationsthatprovidefreeorlowcostservicestocancer
 patients(mealservices,transportationthroughlocalchurchor
volunteerorganizations,childcareoreldercaresupportand
respiteservices)orlocalfundsprovidingfinancialassistance

 

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CancerOrganizations

NationalGeneralCancerResources Website
 
ASCOCancerFoundation Cancer.net
AmericanCancerSociety  Cancer.org
CancerSupportCommunity CancerSupportCommunity.org
LIVESTRONG LIVESTRONG.org
NationalCancerInstitute  Cancer.gov
NationalCoalitionforCancerSurvivorship Canceradvocacy.org
 
SupportGroupOrganizationsbyCancerType 
 
Bladder 
 BladderCancerAdvocacyNetwork  BCAN.org
Brain 
AmericanBrainTumorAssociation  ABTA.org
NationalBrainTumorSociety Braintumor.org
TheBrainTumorFoundation   BrainTumorFoundation.org
Breast 
SusanG.KomenFoundation   Komen.org
Breastcancer.org Breastcancer.org
AvonFoundationforWomen   AvonFoundation.org
Carcinoid 
CaringforCarcinoidFoundation   CaringForCarcinoid.org
TheCarcinoidCancerFoundation  Carcinoid.org
Cervical 
 NationalCervicalCancerCoalition NCCCOnline.org
Colorectal 
 ColorectalCancerCoalition  FightColorectalCancer.org
Gastric 
 GastricCancerFund    GasticCancer.org
GIST(gastrointestinalstromaltumors)  
 GISTSupportInternational   GistSupport.org
HeadandNeck,Esophageal 
 HeadandNeckCancerAlliance  HeadAndNeck.org
Lung 
 LungCancerAlliance   LungCancerAlliance.org
AmericanLungAssociation   LungUSA.org
LeukemiaandLymphoma 
LeukemiaandLymphomaSociety  LLS.org
Liver 

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 AmericanLiverFoundation  LiveFoundation.org
Melanoma 
 AmericanMelanomaFoundation  MelanomaResearchFoundation.org
MelanomaResearchFoundation  Melanoma.org
Oral 
 SupportforPeoplewithOralandHeadandNeck SPOHNC.org
Cancer 
Ovarian 
OvarianCancerNationalAlliance  OvarianCancer.org
RhondasClub    RhondasClub.org
Pancreatic 
 PancreaticCancerActionNetwork  PanCan.org
Prostate 
ProstateCancerResearchInstitute   ProstateCancer.org
UsTooInternational    UsToo.org
Renal 
KidneyCancerAssociation   KidneyCancer.org
Sarcoma 
SarcomaFoundationofAmerica CureSarcoma.org
 SarcomaAlliance    SarcomaAlliance.org
Testicular 
 StanfordMedicalCenter   TesticularCancerSociety.org
Thyroid 
 ThyroidCancerSociety  Thyca.org
Uterine,Vulvular 
FoundationforWomensCancer  FoundationForWomensCancer.org


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ResourcesforPatientNavigators

x IntroductiontoVARK(learningstyles)
Thiswebsiteprovidesinformationaboutdifferentlearningstyles.
x EngagementBehaviorFramework
TheEngagementBehaviorFrameworkoutlinesactivitiespatientscandotobemore
engaged.
x NationalComprehensiveCancerNetworks(NCCN)DistressThermometer
TheNCCNDistressThermometerisaneasytooltousetoassespatientdistress.
x AgencyforHealthcareResearchandQualitysHealthLiteracyMeasurementTools
ThiswebpageincludestoolsinEnglishandSpanishtoassesshealthliteracy.
x CentersforDiseaseControlandPreventionsHealthLiteracySection
Thiswebsiteprovidesinformationandtoolstoimprovehealthliteracyandpublic
health.Theseresourcesareforallorganizationsthatinteractandcommunicatewith
peopleabouthealth.
x StanfordSchoolofMedicinesWorkingwithProfessionalInterpreters
This18minutevideoprovidesanoverviewofworkingwithprofessionalinterpreters.

ResourcesforPatients

x TheVARKQuestionnaire
Thisquestionnairehelpspeoplefigureouttheirlearningstyle.
x EngagementBehaviorFramework
TheEngagementBehaviorFrameworkoutlinesactivitiespatientscandotobemore
engaged.
x OttawaPersonalDecisionGuides
Theseguidescanhelpwithanyhealthrelatedorsocialdecisions.
x LIVESTRONGFoundationsDevelopingYourTreatmentPlan
Thiswebsiteprovidesguidanceonworkingwithahealthcareprovidertocreatea
treatmentplan.
x AgencyforHealthcareResearchandQualitysQuestionBuilder
Thistoolletspatientsbuildquestionstoasktheirhealthcareteam.
x AmericanCancerSocietysQuestionstoAskMyDoctorAboutMyCancer
Thisresourceprovidesalistofquestionswhenyouretoldyouhavecancer,when
decidingonatreatmentplan,beforetreatment,duringtreatmentandaftertreatment.
x NationalCoalitionforCancerSurvivorshipsTeamwork:TheCancerPatientsGuideTo
TalkingWithYourDoctor
Thisbookcoverstipsforunderstandinghowtotalkwithyourdoctor,background
informationandstaging,copingwithadiagnosis,treatmentoptions,costandinsurance
issues,treatmentplanning,transitioningofftreatment,whentreatmentoptionsare
limitedandlivingwithloss.
 

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Module4,Lesson3:SharedDecisionMaking
References:Presentation
AdamsKG,GreinerAC,CorriganJM(Eds.),CommitteeontheCrossingtheQualityChasm:Next
StepsTowardaNewHealthCareSystem.2004.The1stAnnualCrossingtheQualityChasm
Summit:AFocusonCommunities.Washington(DC):NationalAcademiesPress.ISBN:0309
093031.
BaloghEP,GanzPA,MurphySB,NassSJ,FerrellBR,StovallE.Patientcenteredcancer
treatmentplanning:improvingthequalityofoncologycare.SummaryofanInstituteof
Medicineworkshop.Oncologist.2011;16(12):18005.doi:10.1634/theoncologist.20110252.
BeagleyL.Educatingpatients:understandingbarriers,learningstyles,andteachingtechniques.
JPerianesthNurs.2011;26(5):331337.doi:10.1016/j.jopan.2011.06.002.
ButterworthSW.Influencingpatientadherencetotreatmentguidelines.JManagCarePharm.
2008;14(6SupplB):2124.
CornettS.Assessingandaddressinghealthliteracy.OJIN.2009;14(3):Manuscript2.doi:
10.3912/OJIN.Vol14No03Man02.
CoulterA,ParsonsS,AskhamJ.Wherearethepatientsindecisionmakingabouttheirown
care.2008.Retrievedfrom:
http://www.who.int/management/general/decisionmaking/WhereArePatientsinDecisionMakin
g.pdf.
EpsteinRM,StreetRLJr.Patientcenteredcommunicationincancercare:Promotinghealing
andreducingsuffering.NationalCancerInstitute,NIHPublicationNo.076225.Bethesda,MD,
2007.
Fleming,ND,Mills,C.Notanotherinventory,ratheracatalystforreflection.ToImprovethe
Academy.1992;11:137155.
FraenkelL,McGrawS.Whataretheessentialelementstoenablepatientparticipationin
medicaldecisionmaking.JGenInternMed.2007;22(5):614619.doi:10.1007/s11606007
01499.
InottT,KennedyBB.Assessinglearningstyles:practicaltipsforpatienteducation.NursClin
NorthAm.2011;46(3):31320,vi.doi:10.1016/j.cnur.2011.05.006.
InstituteofMedicineCommitteeonHealthLiteracy.BoardonNeuroscienceandBehavioral
Health.NielsenBohlmanL,PanzerA,King,DA(Eds).2004.HealthLiteracy:APrescriptiontoEnd
Confusion.Washington(DC):NationalAcademiesPress(US).ISBN:0309091179.Retrieved
from:http://www.nap.edu/catalog.php?record_id=10883.
KutnerM,GreenbergE,JinY,PaulsenC.(2006).ThehealthliteracyofAmericasadults:Results
fromthe2003nationalassessmentofadultliteracy.(NCES2006483).U.S.Departmentof
Education.Washington,D.C.Retrievedfrom:
http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483.

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LowesR.Patientcenteredcareforbetterpatientadherence.FamPractManag.1998;5(3):46
47,5154,57.
McCorkleR,ErcolanoE,LazenbyM,etal.Selfmanagement:Enablingandempoweringpatients
livingwithcancerasachronicillness.CACancerJClin.2011;61(1):5062.doi:
10.3322/caac.20093.
NationalCouncilonInterpretinginHealthcare.WhatsinaWord?AGuidetoUnderstanding
InterpretingandTranslationinHealthCare.2010.Retrievedfrom:
http://www.ncihc.org/assets/documents/publications/Whats_in_a_Word_Guide.pdf.
PearsonML,MattkeS,ShawR,RidgelyMS,WisemanSH.PatientSelfManagementSupport
Programs:AnEvaluation.FinalContractReport(PreparedbyRANDHealthunderContractNo.
282000005).Rockville,MD:AgencyforHealthcareResearchandQuality;November2007.
AHRQPublicationNo.080011.
RobinsonTE2nd,WhiteGLJr,HouchinsJC.Improvingcommunicationwitholderpatients:tips
fromtheliterature.FamPractManag.2006;13(8):7378.
SheridanSL,HarrisRP,WoolfSH,SharedDecisionMakingWorkgroupoftheU.S.Preventive
ServicesTaskForce.Shareddecisionmakingaboutscreeningandchemoprevention:A
suggestedapproachfromtheU.S.preventativetaskforce.AmJPrevMed.2004;26(1):5666.
doi:10.1016/j.amepre.2003.09.011.
SupportingPatients'DecisionMakingAbilitiesandPreferences.2006.InInstituteofMedicine
(US)CommitteeonCrossingtheQualityChasm:AdaptationtoMentalHealthandAddictive
Disorders.ImprovingtheQualityofHealthCareforMentalandSubstanceUseConditions:
QualityChasmSeries.Washington(DC):NationalAcademiesPress(US).Retrievedfrom:
http://www.ncbi.nlm.nih.gov/books/NBK19831/.
U.S.DepartmentofHealthandHumanServices.HealthLiteracyBasics.n.d.Retrievedfrom:
http://www.health.gov/communication/literacy/quickguide/factsbasic.htm.
U.S.DepartmentofHealthandHumanServices.ImprovetheUsabilityofHealthInformation.
n.d.Retrievedfrom:
http://www.health.gov/communication/literacy/quickguide/healthinfo.htm.
References:BriefQuizReferences:PostTest
BaloghEP,GanzPA,MurphySB,NassSJ,FerrellBR,StovallE.Patientcenteredcancer
treatmentplanning:improvingthequalityofoncologycare.SummaryofanInstituteof
Medicineworkshop.Oncologist.2011;16(12):18005.doi:10.1634/theoncologist.20110252.
BeagleyL.Educatingpatients:understandingbarriers,learningstyles,andteachingtechniques.
JPerianesthNurs.2011;26(5):331337.doi:10.1016/j.jopan.2011.06.002.
ButterworthSW.Influencingpatientadherencetotreatmentguidelines.JManagCarePharm.
2008;14(6SupplB):2124.

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MODULE4: 
Resources
THEBASICSOFPATIENTNAVIGATION

CoulterA,ParsonsS,AskhamJ.Wherearethepatientsindecisionmakingabouttheirown
care.2008.Retrievedfrom:
http://www.who.int/management/general/decisionmaking/WhereArePatientsinDecisionMakin
g.pdf.
EpsteinRM,StreetRLJr.Patientcenteredcommunicationincancercare:Promotinghealing
andreducingsuffering.NationalCancerInstitute,NIHPublicationNo.076225.Bethesda,MD,
2007.
FraenkelL,McGrawS.Whataretheessentialelementstoenablepatientparticipationin
medicaldecisionmaking.JGenInternMed.2007;22(5):614619.doi:10.1007/s11606007
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LowesR.Patientcenteredcareforbetterpatientadherence.FamPractManag.1998;5(3):46
47,5154,57.
RobinsonTE2nd,WhiteGLJr,HouchinsJC.Improvingcommunicationwitholderpatients:tips
fromtheliterature.FamPractManag.2006;13(8):7378.
SheridanSL,HarrisRP,WoolfSH,SharedDecisionMakingWorkgroupoftheU.S.Preventive
ServicesTaskForce.Shareddecisionmakingaboutscreeningandchemoprevention:A
suggestedapproachfromtheU.S.preventativetaskforce.AmJPrevMed.2004;26(1):5666.
doi:10.1016/j.amepre.2003.09.011.


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