Shared Decision-Making with Patients with Multimorbidity and Limited Health Literacy: The Importance of Values Clarification.

Patients with multimorbidity (having two or more chronic conditions) often face complex health decisions involving trade-offs, competing outcomes, and cumulative treatment burden. Shared decision-making (SDM) can support these decisions by applying values clarification: identifying what matters to a patient, a key component of SDM. Values clarification is particularly important for patients with multimorbidity, as separate disease-specific recommendations may conflict and overlook what matters to the patient. Despite its importance, values clarification is underused, particularly when communication is challenging. This challenge is especially seen in patients with limited health literacy, who often struggle to understand information, weigh alternatives, and articulate what matters to them. Multimorbidity and limited health literacy often co-occur, increasing both need and potential benefit of values clarification. Some tools can support values clarification, but most are not designed for patients with multimorbidity and limited health literacy. For these patients, SDM may need to start with values clarification, relying more on dialogue than on formal tools. Targeted training for healthcare professionals may help them navigate complex decisions and integrate patient values. Future work should focus on developing and evaluating methods in collaboration with patients and healthcare professionals, ensuring that SDM and values clarification are accessible, feasible, and genuinely person-centered.