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First, thanks to all the contributors for an amazing month of insightful articles on health literacy and shared decision making. If you missed any, here's a recap.

Steven Kussin kicked things off by asking how patients can gain enough knowledge so they can be empowered to make informed, preference-driven decisions. But with more complex medical decisions do patients need even more advanced literacy?

Corey Siegel identified a black hole of information for both practitioners and patients: cost. Too many times people find out only after they choose a treatment what it will cost, what will be covered. How can we expect anyone to make long or short term decisions without this information?

Matthew Wynia and Andrew Jager asked what organizations can do to encourage and create an environment where shared decision making can occur. The Communication and Climate Assesment Toolkit identifies health literacy strategies like teach back and creating a space where patients feel safe and encouraged to ask questions.

Jan Prochaska looked at shared decision making through the lens of the transtheoretical model of behavior change. Plain language and user-centered design are key, but giving patients the right messages at the right time is essential for them to understand it and act on it.

Peter Ubel demonstrated that even well-meaning attempts to give patients the information they need to make a decision, it’s easy it is to quickly overwhelm patients with a tangle of numbers, percentages, duration and medical jargon. How can patients and practitioners find a common language?

Diana Dilger drew on her experience developing decision aids to talk about tone, and how easy it is to turn people off if you don't strike the right tone for each population.

Joanne Schwartzberg pointed out that while decision aids help bridge the information and health literacy gap, the communication that takes place (or doesn't ) during the patient-physician encounter is still at the center of helping patients understand information as well as their own values and preferences.

Holly Witteman's excellent piece on trade-offs in shared decisions acknowledged they’re not just difficult choices people have to wrestle with, but often difficult concepts in their own right.

A mini-series within the series
A week of articles then took a closer look at health literacy and shared decisions around palliative care and advanced directives.

I challenged companies to educate employees about advanced directives

Diane Meier discussed how both physicians and patients are often in the dark about what palliative care is. And as a result too many people are not getting this essential care.

Alexandra Drane spoke from experience about how discussing death is something we as a culture avoid. We keep ourselves and our families in the dark. She proposed five questions to get the conversation going.

Monica Williams-Murphy looked at surrogate medical decision making and how we make health decisions for others when they can no longer make decisions for themselves.

And Susan Dolan asked why we'll plan for a wedding or a birth, but we often fail to plan for the end of our life. She provided a checklist to help start this process.

Jim Merlino called for communication training for physicians and shared decision making tools they can use with patients for more effective and meaningful encounters.

David Rubin remembered his physician mentor as an example of a doctor who knew how to work with, treat, and know his patients.

David Sobel looked at the challenges of communicating about end of life treatment decisions, even within a medical family.

Nadia Ali called for using community members to understand each hospital’s specific health literacy challenges and needs.

Gary Schwitzer looked at how the large number of often inaccurate health news stories confuses rather than helps the goal of shared decision making.

We look forward to another exciting Health Literacy Month next year and many thanks again for all who participated in this series!

Geri Baumblatt Geri Baumblatt, Editorial Director