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Karabukayeva A, Hearld LR, Choi S, Singh JA. Patient Perspectives on a Decision Aid for Systemic Lupus Erythematosus: Insights and Future Considerations. J Rheumatol 2024; 51:798-803. [PMID: 38749565 DOI: 10.3899/jrheum.2023-1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide spectrum of clinical manifestations. A decision aid (DA) for SLE was developed and implemented in 15 rheumatology clinics throughout the United States. This study explored the experiences of patients who viewed the DA to understand how patients engage with and respond to the SLE DA. METHODS We conducted a qualitative descriptive study using semistructured interviews with a convenience sample of 24 patients during May to July 2022. RESULTS Patients recognized the value of the SLE DA in providing general knowledge about SLE and different treatment options. However, patients expressed a desire for more comprehensive lifestyle information to better manage their condition. Another theme was the importance of having multiple formats available to cater to their different needs, as well as tailoring the DA to different stages of SLE. CONCLUSION This study contributes to a broader understanding of how to provide patient-centered care for patients with SLE by offering practical insights that can inform the development of more effective, patient-centric health information technologies for managing chronic diseases, ultimately improving patient outcomes. Overall, this study underscores the significance of optimizing both the information content and determining the appropriate delivery of the tool for its future sustainability.
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Affiliation(s)
- Aizhan Karabukayeva
- A. Karabukayeva, PhD, Health Administration and Policy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
| | - Larry R Hearld
- L.R. Hearld, PhD, Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Seongwon Choi
- S. Choi, PhD, Department of Management, College of Business and Economics, California State University Los Angeles, Los Angeles, California
| | - Jasvinder A Singh
- J.A. Singh, MD, MPH, Division of Immunology and Rheumatology, Heersink School of Medicine, UAB, Medicine Service and Geriatric Research Education and Clinical Center (GRECC), VA Medical Center, Department of Medicine at the School of Medicine, UAB, and Department of Epidemiology, UAB School of Public Health, Birmingham, Alabama, USA.
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Galindo Izquierdo M, Borrás Blasco J, Pérez Ortega S, Salman-Monte TC, Vela-Casasempere P, Rodríguez Almaraz E, Calvo-Alen J, Álvaro-Gracia Álvaro JM, Barbado Ajo MJ, Rubio Renau R, Galvez-Fernandez M, Bahamontes-Rosa N, Sánchez-Covisa Hernández J, Solà Marsiñach C. Lack of awareness of systemic lupus erythematosus and its consequences in a cohort of moderate and severe patients in Spain: The LupusVoice study. Lupus 2024; 33:663-674. [PMID: 38577967 PMCID: PMC11193315 DOI: 10.1177/09612033241242886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Systemic lupus erythematosus (SLE) is an autoimmune condition that can highly impact patients' quality of life (QoL). However, there is a lack of knowledge about SLE, affecting the general population and health care professionals (HCPs) alike. This lack of knowledge has negative implications for patients and the healthcare system, worsening prognosis, negatively impacting QoL, and increasing healthcare utilization. The aim of this paper is to draw attention, according to the perspective of the participants of this study, to the lack of awareness of SLE and its consequences in Spain, and to suggest improvements. PATIENTS AND METHODS This qualitative, descriptive, observational, multicenter, and cross-sectional study included 40 patients with moderate or severe SLE, recruited during their routine visits in six university hospitals in Spain. The study also included 11 caregivers and 9 HCPs. All participants were individually interviewed. Data from the interviews were coded and analyzed thematically by two anthropologists following a phenomenological perspective. RESULTS Our study identified a lack of disease awareness among primary care physicians, emergency medicine doctors, and other specialists treating SLE symptomatology. This led to diagnostic delays, which had a clinical and emotional impact on patients. Furthermore, symptom awareness was found to be context dependent. Differences in symptom awareness between HCPs and patients led to a mismatch between the severity evaluation made by doctors and patients. Some HCPs did not consider the limitations of the current severity evaluation of SLE, and therefore attributed symptoms potentially caused by SLE to the unfavorable socioeconomic conditions patients lived in. Finally, a lack of social awareness among friends, family members, and romantic partners led to lower social support, increased isolation, and negative physical and emotional impact for patients. Gender differences in the provision of support were identified. CONCLUSION This study highlights the need to increase SLE awareness among patients, HCPs, and the broader public in order to improve patient QoL. Being aware of the clinical and emotional impact of such lack of awareness, as well as the role played by context on the patient experience of SLE, is a crucial step towards achieving this goal.
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Affiliation(s)
| | | | | | | | - Paloma Vela-Casasempere
- Rheumatology Department, Hospital General Universitario Dr Balmis Alicante/ISABIAL/Universidad Miguel Hernandez, Alicante, Spain
| | | | - Jaime Calvo-Alen
- Rheumatology Department, Hospital Universitario Araba, Instituto de Investigación BIORABA, Universidad del País Vasco, Vitoria-Gasteiz, Spain
| | | | - Mͣ Julia Barbado Ajo
- Internal Medicine Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Raül Rubio Renau
- Evidence Generation Department, A Piece of Pie, Barcelona, Spain
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3
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Oguro N, Yajima N, Ishikawa Y, Sakurai N, Hidekawa C, Ichikawa T, Kishida D, Hayashi K, Shidahara K, Miyawaki Y, Yoshimi R, Sada KE, Shimojima Y, Kurita N. Effect of Attending Rheumatologists' Big 5 Personality Traits on Patient Trust in Patients With Systemic Lupus Erythematosus: The TRUMP2-SLE Project. J Rheumatol 2024; 51:168-175. [PMID: 37914212 DOI: 10.3899/jrheum.2023-0603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Differences in communication styles based on physicians' personality traits have been identified, particularly in primary care, and these physician-related factors can be important in building patient-physician trust. This study examined the effects of rheumatologists' personality traits on patients' trust in their attending rheumatologists. METHODS This cross-sectional study included adult Japanese patients with systemic lupus erythematosus (SLE) at 5 academic medical centers between June 2020 and August 2021. The exposures were the Big 5 personality traits (ie, extraversion, agreeableness, openness, conscientiousness, and emotional stability) of attending rheumatologists using the Japanese version of the 10-Item Personality Inventory scale (1-7 points each). The outcome was the patients' trust in their attending rheumatologist using the Japanese version of the 5-item Wake Forest Physician Trust Scale (0-100 points). A general linear model was fitted. RESULTS The study included 505 patients with a mean age of 46.8 years; 88.1% were women. Forty-three attending rheumatologists (mean age: 39.6 years; 23.3% female) were identified. After multivariable adjustment, higher extraversion and agreeableness were associated with higher trust (per 1-point increase, 3.76 points [95% CI 1.07-6.45] and 4.49 points [95% CI 1.74-7.24], respectively), and higher conscientiousness was associated with lower trust (per 1-point increase, -2.17 points [95% CI -3.31 to -1.03]). CONCLUSION Whereas higher extraversion and agreeableness of attending rheumatologists led to higher patient trust in their rheumatologist, overly high conscientiousness may lead to lower trust resulting from the physicians' demand of responsibility and adherence to instructions from patients with SLE.
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Affiliation(s)
- Nao Oguro
- N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, and Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto
| | - Nobuyuki Yajima
- N. Yajima, MD, PhD, MPH, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima
| | - Yuichi Ishikawa
- Y. Ishikawa, MD, The First Department of Internal Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, and Graduate School of Health Innovation, Kanagawa University of Human Services, Yokosuka
| | - Natsuki Sakurai
- N. Sakurai, MD, C. Hidekawa, MD, R. Yoshimi, MD, PhD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Chiharu Hidekawa
- N. Sakurai, MD, C. Hidekawa, MD, R. Yoshimi, MD, PhD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Takanori Ichikawa
- T. Ichikawa, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, and Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Dai Kishida
- D. Kishida, MD, PhD, Y. Shimojima, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Keigo Hayashi
- K. Hayashi, MD, PhD, K. Shidahara, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Kenta Shidahara
- K. Hayashi, MD, PhD, K. Shidahara, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Yoshia Miyawaki
- Y. Miyawaki, MD, PhD, MPH, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, and Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama
| | - Ryusuke Yoshimi
- N. Sakurai, MD, C. Hidekawa, MD, R. Yoshimi, MD, PhD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama
| | - Ken-Ei Sada
- K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku
| | - Yasuhiro Shimojima
- D. Kishida, MD, PhD, Y. Shimojima, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Noriaki Kurita
- N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.
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Parodis I, Gomez A, Tsoi A, Chow JW, Pezzella D, Girard C, Stamm TA, Boström C. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. RMD Open 2023; 9:e003297. [PMID: 37532469 PMCID: PMC10401222 DOI: 10.1136/rmdopen-2023-003297] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Through this systematic literature review, we assembled evidence to inform the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We screened articles published between January 2000 and June 2021. Studies selected for data extraction (118 for SLE and 92 for SSc) were thematically categorised by the character of their intervention. Of 208 articles included, 51 were classified as robust in critical appraisal. Physical activity was the most studied management strategy and was found to be efficacious in both diseases. Patient education and self-management also constituted widely studied topics. Many studies on SLE found psychological interventions to improve quality of life. Studies on SSc found phototherapy and laser treatment to improve cutaneous disease manifestations. In summary, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment but should not aim to substitute the latter when this is deemed required. While some management strategies i.e., physical exercise and patient education, are already established in current clinical practice in several centres, others e.g., phototherapy and laser treatment, show both feasibility and efficacy, yet require testing in more rigorous trials than those hitherto conducted.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Denise Pezzella
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard
- Division of Rheumatology, Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Vienna, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Leung J, Som A, McMorrow L, Zickuhr L, Wolbers J, Bain K, Flood J, Baker EA. Rethinking the Difficult Patient: Formative Qualitative Study Using Participatory Theater to Improve Physician-Patient Communication in Rheumatology. JMIR Form Res 2023; 7:e40573. [PMID: 36877547 PMCID: PMC10028511 DOI: 10.2196/40573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Effective physician-patient communication is crucial for positive health outcomes for patients with chronic diseases. However, current methods of physician education in communication are often insufficient to help physicians understand how patients' actions are influenced by the contexts within which they live. An arts-based participatory theater approach can provide the necessary health equity framing to address this deficiency. OBJECTIVE The aim of this study was to develop, pilot, and conduct a formative evaluation of an interactive arts-based communication skills intervention for graduate-level medical trainees grounded in a narrative representative of the experience of patients with systemic lupus erythematosus. METHODS We hypothesized that the delivery of interactive communication modules through a participatory theater approach would lead to changes in both attitudes and the capacity to act on those attitudes among participants in 4 conceptual categories related to patient communication (understanding social determinants of health, expressing empathy, shared decision-making, and concordance). We developed a participatory, arts-based intervention to pilot this conceptual framework with the intended audience (rheumatology trainees). The intervention was delivered through routine educational conferences at a single institution. We conducted a formative evaluation by collecting qualitative focus group feedback to evaluate the implementation of the modules. RESULTS Our formative data suggest that the participatory theater approach and the design of the modules added value to the participants' learning experience by facilitating interconnection of the 4 communication concepts (eg, participants were able to gain insight into both what physicians and patients were thinking about on the same topic). Participants also provided several suggestions for improving the intervention such as ensuring that the didactic material had more active engagement and considering additional ways to acknowledge real-world constraints (eg, limited time with patients) in implementing communication strategies. CONCLUSIONS Our findings from this formative evaluation of communication modules suggest that participatory theater is an effective method for framing physician education with a health equity lens, although considerations in the realms of functional demands of health care providers and use of structural competency as a framing concept are needed. The integration of social and structural contexts into the delivery of this communication skills intervention may be important for the uptake of these skills by intervention participants. Participatory theater provided an opportunity for dynamic interactivity among participants and facilitated greater engagement with the communication module content.
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Affiliation(s)
- Jerik Leung
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Avira Som
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Lily McMorrow
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Lisa Zickuhr
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - John Wolbers
- Metro Theater Company, St. Louis, MO, United States
| | - Karen Bain
- Metro Theater Company, St. Louis, MO, United States
| | - Julia Flood
- Metro Theater Company, St. Louis, MO, United States
| | - Elizabeth A Baker
- Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
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Colmenares-Roa T, Gastelum-Strozzi A, Crosley E, Fuentes-Silva Y, Reategui-Sokolova C, Elera-Fitzcarrald C, Ibañez S, Cairoli E, Pons-Estel BA, Drenkard C, Peláez-Ballestas I. Digital Narratives of Living With Lupus: Lived Experiences and Meanings for Latin American and Latino Patients and Their Families. Arthritis Care Res (Hoboken) 2023; 75:540-549. [PMID: 35188345 DOI: 10.1002/acr.24870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/20/2022] [Accepted: 02/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) disproportionately affects Latin American and Latino populations, with worse outcomes compared to nonminority populations. Understanding patients' views is critical to provide culturally competent care. The objective of this research is to analyze lived experiences with SLE from comments made by Latin American and Latino patients, and their relatives and friends, on the public Facebook group "Hablemos de Lupus" (in English: "Let's Talk about Lupus"). METHODS Deidentified narratives posted as a reaction to the most popular resources shared by the page were extracted using the Facepager application. We conducted a thematic analysis under an interpretative medical anthropology framework. RESULTS Five core themes were demonstrated by social media comments: lived experiences with lupus, religious/spiritual thoughts, metaphors, heredity, and experiences of family and friends. Being diagnosed with lupus is perceived as a life-changing event. The fluctuating course of the disease causes uncertainty, and the perception of invisibility within the patient's social circle generates feelings of being misunderstood. Faith and spiritual thoughts are coping strategies. Patients use metaphors about the disease's meaning and their lived experiences (the purple butterfly, not belonging, bellicose metaphors) to communicate with others. Relatives and friends are impacted by their loved one's distress. CONCLUSION Patients perceive lupus as an unpredictable illness and use metaphors to foster empathy and communicate their experiences to others. Religion is as important as medical treatment to cope with the disease, and the experience of having lupus extends to family and friends. Findings can be used to improve physician-patient communication and lupus education campaigns in the Latin American and Latino population.
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Affiliation(s)
| | | | | | | | | | | | | | - Ernesto Cairoli
- Centro Asistencial del Sindicato Médico del Uruguay and Hospital Evangélico and Institut Pasteur de Montevideo, Montevideo, Uruguay
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7
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Hu Y, Gao RC, Sang N, Wu L, Shi PL, Wu GC. Influencing factors of self-disclosure and its impact on quality of life in patients with systemic lupus erythematosus. Lupus 2023; 32:207-215. [PMID: 36470586 DOI: 10.1177/09612033221143935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Self-disclosure may enhance positive illness perceptions, whereas patients with systemic lupus erythematosus (SLE) always facing negative illness perceptions due to multiple reasons, so elucidation of factors affecting self-disclosure may facilitate the development of quality of life. METHODS A total of 161 hospitalized patients with SLE were recruited. Scales on demographic and clinical characteristics, self-disclosure, psychosocial status (e.g. Social Support Rating Scale - SSRS) and quality of life were used to collect related information from clients. Univariate analysis was performed by Kruskal-Wallis rank-sum test or chi-square test, and multivariate analysis by ordinal logistic regression. RESULTS Social support, drinking, depression and cause of hospitalization were found to be influencing factors of self-disclosure. Multiple logistic regression analyses revealed that the significant and independent factors associated with self-disclosure in patients with SLE were social support, drinking and depression. Domains of LupusQoL, except physical health and fatigue, were positively correlated with self-disclosure. CONCLUSIONS With the increase of social support, the level of self-disclosure become worse, drinking, depression and cause of hospitalization are risk factors for it. Moreover, the level of self-disclosure is positively related to the LupusQoL. Medical staff should formulate effective measures according to the results to improve self-disclosure in patients with SLE and promote their quality of life.
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Affiliation(s)
- Yang Hu
- School of Nursing, 12485Anhui Medical University, Hefei, Anhui, China
| | - Rui-Chen Gao
- School of Nursing, 12485Anhui Medical University, Hefei, Anhui, China
| | - Ni Sang
- School of Nursing, 12485Anhui Medical University, Hefei, Anhui, China
| | - Li Wu
- School of Nursing, 12485Anhui Medical University, Hefei, Anhui, China
| | - Pei-Li Shi
- School of Nursing, 12485Anhui Medical University, Hefei, Anhui, China
| | - Guo-Cui Wu
- School of Nursing, 12485Anhui Medical University, Hefei, Anhui, China
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Blackie CA, Gualtieri L, Kasturi S. Listening to Lupus Patients: Proactively Integrating the Internet as a Resource to Drive Improved Care. (Preprint). J Med Internet Res 2022; 25:e44660. [PMID: 36989021 PMCID: PMC10131912 DOI: 10.2196/44660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/17/2023] [Accepted: 03/12/2023] [Indexed: 03/14/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. It is characterized by a broad spectrum of manifestations, depending on the affected organs and the severity of the inflammation at the time of presentation. Despite improvements in management, treatments are required on a chronic, cyclical basis; have high potential for unpleasant side effects; and deliver variable efficacy. Patients require care from multiple specialists, which can be delivered simultaneously and sporadically. Our fragmented health care system further exacerbates the disconnect between intermittent medical care and the lived experiences of patients with SLE. The goals of this research are to (1) assess the current standard of care for patients with SLE through the review of medical literature, including clinical consensus guidelines and systematic reviews; (2) assess the lived experiences of patients with lupus through the review of peer-reviewed literature on social listening, structured interviews, and data available from the open-access digital health platform PatientsLikeMe; and (3) present the perspective that the medical community has an opportunity to acknowledge and review the use of digital health interventions (DHIs) with their patients. The results of this research indicate that patients are incorporating DHIs, such as the internet and social media platforms, as critical components of their care for even the most basic of support. Although patients with SLE are depending on this support to shape their care, it is not considered a primary source of care by clinicians. Integrating the voices of patients brings valuable dimension to understanding the lived experiences of patients with SLE and the impacts of mutually dependent patient needs as patients navigate the disease in daily life. The medical community has a meaningful opportunity to leverage and recommend existing DHIs, such as web-based community platforms and web-based patient registries, at every stage of the patient journey to help patients better manage their condition. This has the potential to proactively build patient trust and well-being, reduce the underreporting of symptoms, increase shared decision-making, inform and shape clinical guidelines and future research, and improve patient outcomes.
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Affiliation(s)
| | - Lisa Gualtieri
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, United States
| | - Shanthini Kasturi
- Department of Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, United States
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Leung J, McMorrow L, BeLue R, Baker EA. Structural and health system determinants of health outcomes in systemic lupus erythematosus: Understanding the mechanisms underlying health disparities. Front Public Health 2022; 10:980731. [PMID: 36249243 PMCID: PMC9563342 DOI: 10.3389/fpubh.2022.980731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
Chronic diseases are increasingly responsible for the burden of health outcomes across the world. However, there is also increasing recognition that patterns of chronic disease outcomes (e.g., mortality, quality of life, etc.) have inequities across race, gender, and socioeconomic groups that cannot be solely attributed to these determinants. There is a need for an organizing framework which centers fundamental causes of health disparities that may better guide future work in centering these mechanisms and moving beyond acknowledgment of health disparities. In this paper, we synthesize several concepts from health disparities literature into a conceptual framework for understanding the interplay of patients' lived experiences, the health care system and structural determinants. Our framework suggests that (1) structural factors influence the health care system, the patient, the health care provider, and the provider-patient relationship through process of subordination and (2) that structurally competent actions are critical to reducing health inequities. The addition of subordination to theoretical frameworks involving health equity and social determinants of health, along with engagement with concepts of structural competency suggest several systems level changes to improve health outcomes.
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Affiliation(s)
- Jerik Leung
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States,*Correspondence: Jerik Leung
| | - Lily McMorrow
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, United States
| | - Rhonda BeLue
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, United States
| | - Elizabeth A. Baker
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
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A Controlled Community Study of Distress and Resilience in Women Diagnosed with Fibromyalgia and Systemic Lupus Erythematosus. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09903-7. [PMID: 35995960 DOI: 10.1007/s10880-022-09903-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
This study examines psychological and physical influences on the distress and well-being of patients with chronic rheumatic diseases. The study aims were to (1) evaluate the relative contribution of objective disease activity and psychological factors on the wellbeing of patients with systemic lupus erythematosus (SLE); (2) to compare the psychological distress of SLE patients to fibromyalgia (FM) patients and healthy controls, and to (3) characterize subgroups of patients by performing cluster analysis using psychological variables. Participants were ascertained from closed forums and social media channels resulting in 41 women with a diagnosis of SLE, 47 with a diagnosis of FM, and 77 healthy controls (HC). Hierarchical linear regression for well-being of SLE patients found that most of the variance was accounted for by social support. Cluster analysis performed on the entire sample identified two clusters, a distressed group tending to Type D personality, anxiety and depression, low in well-being and social support, and a resilient group; the proportion of resilient individuals was highest in the HC intermediate in the SLE group and lowest in the FM group. The importance of psychological variables vs disease severity in these two rheumatic diseases for wellbeing is demonstrated by these results. The results suggest that psychological interventions that enhance the experience of social support in medical settings, might benefit patients with both diseases, and be of particular importance to the well-being of patients who are more distressed.
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Mazzoni D, Baker EA, Hudson DL, Pravettoni G. Editorial: The Impact of Social Connections on Patients' Health. Front Psychol 2022; 13:909498. [PMID: 35572282 PMCID: PMC9096213 DOI: 10.3389/fpsyg.2022.909498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Elizabeth A Baker
- Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
| | - Darrell L Hudson
- Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Broadway-Duren JB, Cesario SK. The Lived Experiences of Women Seeking a Diagnosis of Systemic Lupus Erythematosus. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leung J, Kloos L, Kim AH, Baker EA. Development of a digital toolkit to improve quality of life of patients with systemic lupus erythematosus. Digit Health 2021; 7:20552076211033423. [PMID: 34408903 PMCID: PMC8365175 DOI: 10.1177/20552076211033423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Objective The purpose of this manuscript is to detail development and initial usability
testing of an e-toolkit designed to provide skills and knowledge around
self-management behaviors for individuals living with systemic lupus
erythematosus. Methods Researchers worked with a steering committee of patients and providers to (1)
develop a clickable prototype of an e-toolkit and (2) conduct alpha
(individuals not affiliated with an academic clinic as patient or provider)
and beta (individual patients with systemic lupus erythematosus as well as
members of the clinic healthcare team and individuals who work in patient
advocacy organizations) usability testing through semistructured
interviews. Results During the review of the e-toolkit, the feedback provided by participants in
both alpha and beta groups centered on two overarching themes: (1) improving
user interface and materials and (2) integration of information and supports
between toolkit and clinical personnel. Conclusion Digital approaches that are tailored to individual symptom variation and
integrated with a clinical system have the opportunity to enhance ongoing
clinical care. These findings support movement toward integrated, team-based
care models, tailored digital resources, and use of expanded virtual
interaction options to ensure on-going engagement between healthcare
providers and systemic lupus erythematosus patients.
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Affiliation(s)
- Jerik Leung
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, USA
| | | | - Alfred Hj Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, USA
| | - Elizabeth A Baker
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, USA
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Leung J, Baker EA, Kim AHJ. Exploring intentional medication non-adherence in patients with systemic lupus erythematosus: the role of physician-patient interactions. Rheumatol Adv Pract 2021; 5:rkaa078. [PMID: 33604502 PMCID: PMC7878846 DOI: 10.1093/rap/rkaa078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023] Open
Abstract
Objective Medication non-adherence contributes to worse health outcomes among SLE patients. The underlying mechanisms that drive medication non-adherence are poorly understood. The purpose of this study was to explore possible mechanisms of medication non-adherence by eliciting patient experiences. Methods Consented adult patients with ACR- or SLICC-classified SLE were recruited. Ten semi-structured interviews were conducted across six participants. Interviews were audio recorded, transcribed, and analysed using an iterative process. The findings were presented to an interactive public forum with SLE patients, family members and friends of patients, and health-care professionals to assess validity and for elaboration of the concepts developed. Results The following three interrelated themes emerged from the interviews. First, why do rheumatologists not know more about lupus or share what they do know with their patients? Second, why do I have to take so many drugs and why do the drugs not work? Third, if my rheumatologist cannot communicate with me, why should I follow the prescribed medication regimen? Conclusion Our exploratory findings lay out a possible underlying logic by which patients might choose intentionally to engage with medication non-adherence behaviours. Patients suggested that poor communication with their rheumatologists along with a lack of validation of their symptoms contributed to them not valuing the recommendations of physicians. This also contributed to development of a cynical outlook and little belief that medication would improve their condition. Although further work is needed to validate these findings, our preliminary work suggests that interventions focusing on the development of communication skills among both patients and rheumatologists are necessary to reduce medication non-adherence.
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Affiliation(s)
- Jerik Leung
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University
| | - Elizabeth A Baker
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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Ra JH, Leung J, Baker EA, Kim AHJ. Patient Perspective on Using Digital Resources to Address Unmet Needs in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 73:1568-1576. [PMID: 32741146 DOI: 10.1002/acr.24399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The clinical variability of systemic lupus erythematosus (SLE) caused by the unpredictability of flares contributes to patients experiencing a diminished sense of social support. Digital health interventions (DHIs) have the potential to improve patients' social support but have yet to be studied extensively in SLE. Our objective was to assess general and SLE-specific internet usage as well as specific suggestions for SLE-related digital resources and tools among patients with SLE at the Washington University Lupus Clinic. METHODS Fifty-six participants were recruited from the Washington University Lupus Clinic. Ten-minute structured interviews consisting of multiple choice and open-ended questions were conducted. A descriptive statistical analysis was conducted with the quantitative data, while the qualitative data were analyzed using an open coding approach. RESULTS Nearly all respondents indicated having access to the internet (98.2%). Eighty percent currently use the internet for their SLE. The qualitative data indicate that patients with SLE use the internet for understanding flares and changes in their symptoms and/or laboratory results, want an increased variety of SLE information online, have a desire to exchange personal experiences and knowledge of SLE with others, and desire increased diversity in the methods of delivering digital SLE information. CONCLUSION Our findings support the continued use of DHIs for patients with SLE. We believe that these findings will aid the future development of DHIs tailored to patients with SLE.
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Affiliation(s)
- Jennifer H Ra
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Alfred H J Kim
- Washington University School of Medicine, St. Louis, Missouri
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Theis KA, Brady TJ, Helmick CG, Murphy LB, Barbour KE. Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life. ACR Open Rheumatol 2019; 1:412-423. [PMID: 31777821 PMCID: PMC6857987 DOI: 10.1002/acr2.11050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities. METHODS Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models. RESULTS An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7). CONCLUSION Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life.
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Affiliation(s)
- K. A. Theis
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - T. J. Brady
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - C. G. Helmick
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - L. B. Murphy
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - K. E. Barbour
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
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