Table 2:

Patient skills and competencies and recommendations for healthcare professionals for every stage of the SDM process.

	Functional health literacy		Critical health literacy	Interactive/communicative health literacy
	Understand the disease	Understand the options	Clarify values	Participate in SDM	Make the decision
Skills and competencies for patients	Understanding of written and spoken medical terminology about the disease and its management	Understanding there are risks and benefits to different options and making sense of the likelihood of their occurring	Identifying and clarification values and preferences for possible outcomes and weight this with information on the likelihood of each outcome occurring	Participating in health decisions, feeling able to ask and have the confidence to express their preferences and ask questions to health professionals	Implementing a shared decision and enhancing patient activation
Guidance and recommendations for health professionals	• Use of plain language • Avoid the use of medical jargon • Use clear voice • Use a large font size and clear style (e.g. 12 points or higher and sans serif) • Avoid the use of italic and letters • Avoid the use of acronyms and abbreviations • Incorporate illustrations, cartoons, and videos	• Express probabilistic information as natural frequencies (e.g. 1 in 100) • Use a consistent denominator • Present the information in a variety of formats	• Enhance active forecasting (imagining future health states or events) using imagery and entertainment education techniques • Use personal stories from patients	• Explain to patients and family that choice and the opportunity to participate are available to them if they want it • Use prompt question lists (questions for patients to ask their doctor) to encourage patient participation (e.g. ‘Ask Me 3’ question prompt list)	• Design interventions to enhance patient activation, focusing on self-efficacy, empowerment, and motivation • Remove practical and financial barriers
	Involve patients of all literacy levels in the development of the process