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Tian CY, Wong ELY, Qiu H, Zhao S, Wang K, Cheung AWL, Yeoh EK. Patient experience and satisfaction with shared decision-making: A cross-sectional study among outpatients. PATIENT EDUCATION AND COUNSELING 2024; 129:108410. [PMID: 39217830 DOI: 10.1016/j.pec.2024.108410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/09/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES This study aimed to investigate how doctor-patient communication, trust in doctors impacted patients' experience and satisfaction in shared decision-making (SDM). METHODS This study is based on the data from a cross-sectional survey (n = 12,401) conducted in 27 public specialist outpatient clinics in Hong Kong. RESULTS The multivariable regression models revealed that doctors' better communication skills were associated with lower decision-making involvement (odd ratio, 0.75 [95 % CI, 0.88-0.94], P < .001) but higher satisfaction with involvement (odd ratio, 6.88 [95 % CI, 5.99-7.93], P < .001). Similarly, longer consultation durations were associated with reduced involvement in decision-making (odd ratio, 0.71 [95 % CI, 0.66-0.73], P < .001) but increased satisfaction with involvement (odd ratio, 1.91 [95 % CI, 1.80-2.04], P < .001). Trust in doctors significantly mediated these associations, except for the association between consultation duration and patients' satisfaction with decision-making involvement. CONCLUSION Doctors' better communication skills and longer consultations might not necessarily increase patient involvement in SDM but correlated with increased satisfaction with involvement. Trust in doctors emerged as a mediator for participation and satisfaction in decision-making. PRACTICE IMPLICATIONS Clinics should consider patients' preferences and capabilities when tailoring communication strategies about decision-making and optimizing patient satisfaction.
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Affiliation(s)
- Cindy Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Hong Qiu
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shi Zhao
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Kailu Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Annie Wai-Ling Cheung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ben-Zacharia AB, Smrtka J, Kalina JT, Vignos M, Smith S. Shared decision-making in underserved populations with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2024; 90:105792. [PMID: 39121597 DOI: 10.1016/j.msard.2024.105792] [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] [Received: 03/26/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND The concept of shared decision-making (SDM) is valuable to ensure patients receive individualized care. SDM occurs when healthcare providers engage patients in making personal healthcare decisions that could contribute to better long-term outcomes. With the ever-increasing landscape of treatment options available, SDM can be challenging but valuable for patients. Patients from underserved populations are potentially less likely to engage in SDM, impacting their long-term care. This systematic literature review aimed to explore SDM in these patient populations. METHODS Relevant articles were retrieved from PubMed using key search terms, without any restriction on publication date. All searches and data retrieval were conducted between May 25, 2022, and August 17, 2022, and abstracts were reviewed by two independent reviewers. A thematic analysis was used to present the data. RESULTS All search terms yielded 418 articles; 89 were included (33 involving patients with multiple sclerosis [MS]). Reported mean percentage of patients with MS (including from underserved populations) who preferred SDM was 52 % (range: 37.5-71.5; n = 4). Differences in racial/ethnic assimilation of information communicated by clinicians were reported, impacted by the lower literacy level and certain cultural health beliefs in groups of underserved populations. Primary care clinicians play a key role in providing information to patients in underserved populations. CONCLUSIONS There is a clear benefit for SDM for patients with MS, and without it, patients report dissatisfaction, decisional regret, and lack of confidence in the medical system. However, there are several challenges, including the need for further examination of social determinants of health, for underserved patient populations which still need to be addressed.
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Affiliation(s)
- Aliza Bitton Ben-Zacharia
- Hunter Bellevue School of Nursing and Mount Sinai Hospital; Hunter Bellevue School of Nursing, 425 E 25th St, New York, NY 10010, USA; Mount Sinai, 146 East 126 Street, New York, NY 10035, USA.
| | - Jen Smrtka
- Biogen, 225 Binney St, Cambridge, MA 02142, USA
| | | | | | - Stacyann Smith
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, USA
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Taik FZ, Mansouri NE, Bensaid R, Adnine A, Amar A, Fourtassi M, Abourazzak FE. Beliefs of Moroccan patients with chronic inflammatory rheumatic diseases regarding medication: related factors and correlation with therapeutic adherence. BMC Rheumatol 2024; 8:45. [PMID: 39300521 PMCID: PMC11411903 DOI: 10.1186/s41927-024-00419-1] [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: 08/29/2023] [Accepted: 09/11/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Medication adherence is one of the key elements of the management of patients with chronic inflammatory rheumatic diseases (CIRDs), adherence/medication regimes are prone to being influenced by beliefs about medicines; such beliefs can influence the management and quality of life of patients. Several factors may be associated with these beliefs, including demographic and clinical factors, as well as socio-psychological factors. The aim of this study is to assess beliefs regarding medications among Moroccan patients with CIRDs, the factors associated with these beliefs, and the correlation of these factors with medication adherence. MATERIAL AND METHOD This cross-sectional study included patients with CIRDs. Sociodemographic data, comorbidities, and information about CIRDs (type, disease duration, pain evaluation, disease activity and treatments) were collected. Beliefs regarding medication were assessed by the Belief about Medicine Questionnaire (BMQ). Therapeutic adherence was assessed using the Arabic version of the Compliance Questionnaire in Rheumatology (CQR). Sociopsychological factors, such as catastrophism and trust in physicians, were assessed by the Pain Catastrophizing Scale (PCS) and the Trust in Physicians Scale (TPS), respectively. RESULT Our sample included 189 patients. The average age was 47.49 ± 13.7; 52.4% had comorbidities; and 49.2% had a low level of education. Of the patients, 49.7% were on glucocorticoids, 61.9% on conventional synthetic disease-modifying antirheumatic drugs and 6.3% on biologics. The median necessity-concern differential was 6 [1-12]. Of the patients, 67.4% strongly believed that medication was essential to maintain their health. The long-term side effects were the main concerns about medicines (51.3%). In a multivariate analysis, there was a statistically significant association between low level of education, catastrophizing, methotrexate use, and trust in the physician as independent factors and the BMQ necessity-concern differential as the dependent factor. There was also a significant correlation between CQR and the BMQ necessity score. CONCLUSION Moroccan patients with CIRDs have a rather positive perception of their medication. This perception seems to influence their adherence to treatment. Low levels of education, catastrophizing, methotrexate use, and trust in physicians are the most important factors associated with patients' beliefs regarding medication.
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Affiliation(s)
- Fatima Zahrae Taik
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Noema El Mansouri
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco.
| | - Rajaa Bensaid
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
| | - Anass Adnine
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
| | - Amine Amar
- Applied Mathematics and Data Science, School of Science and Engineering, Al Akhawayn University, Ifrane, Morocco
| | - Maryam Fourtassi
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
- Physical medicine and rehabilitation Department, Mohammed VI University Hospital, Tangier, Morocco
| | - Fatima Ezzahra Abourazzak
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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Yoshimi R, Yajima N, Hidekawa C, Sakurai N, Oguro N, Shidahara K, Hayashi K, Ichikawa T, Kishida D, Miyawaki Y, Sada KE, Shimojima Y, Ishikawa Y, Yoshioka Y, Kunishita Y, Kishimoto D, Takase-Minegishi K, Kirino Y, Ohno S, Kurita N, Nakajima H. Effect of Shared Decision-Making on Trust in Physicians in the Management of Systemic Lupus Erythematosus: The Trust Measurement for Physicians and Patients With Systemic Lupus Erythematosus Prospective Cohort Study. Arthritis Care Res (Hoboken) 2024. [PMID: 39099215 DOI: 10.1002/acr.25409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/09/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE Few studies have explored whether the involvement of patients in shared decision-making (SDM) is beneficial to the management of systemic lupus erythematosus (SLE). Therefore, this study investigated the relationship between patient participation in SDM and their trust in physicians using data from the Trust Measurement in Physicians and Patients With SLE (TRUMP2-SLE) study. METHODS Data regarding the nine-item Japanese version of the Shared Decision-Making Questionnaire (SDM-Q-9) scores, Trust in Physician Scale (TIPS) scores, and Abbreviated Wake Forest Physician Trust Scale (A-WFPTS) scores for interpersonal trust in a physician and trust in the medical profession were collected from patients with SLE who visited the outpatient clinics of five facilities in Japan through a self-administered questionnaire. The relationships among these scores were analyzed by general linear models with cluster-robust variance. RESULTS This study included 433 patients with SLE. The median baseline TIPS and A-WFPTS (attending physician version) scores were 82 (73-93) and 80 (70-95), respectively. A higher baseline SDM-Q-9 score was correlated with an increase in the TIPS score at one year (coefficient per 10-point [pt] increase, 0.94 pts, 95% confidence interval [CI] 0.16-1.72). A higher baseline SDM-Q-9 score was correlated with a higher A-WFPTS score for interpersonal trust (coefficient per 10-pt increase, 2.20 pts, 95% CI 1.44-2.96). The baseline SDM-Q-9 score was also correlated with an increase in the general physician version of the A-WFPTS score at one year (coefficient per 10-pt increase, 1.29 pts, 95% CI 0.41-2.18). CONCLUSION Engagement of patients with SLE in SDM elevates their trust in the attending physicians and health care providers, potentially enhancing doctor-patient relationships and overall health care trust.
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Affiliation(s)
- Ryusuke Yoshimi
- Yokohama City University Graduate School of Medicine and Yokohama City University Hospital, Yokohama, Japan
| | - Nobuyuki Yajima
- Showa University School of Medicine, Tokyo, Kyoto University, Kyoto, and Fukushima Medical University, Fukushima, Japan
| | - Chiharu Hidekawa
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Natsuki Sakurai
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nao Oguro
- Showa University School of Medicine, Tokyo, Japan
| | - Kenta Shidahara
- Okayama University Graduate School of Medicine, Okayama, Japan
| | - Keigo Hayashi
- Okayama University Graduate School of Medicine, Okayama, Japan
| | | | - Dai Kishida
- Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshia Miyawaki
- Okayama University Graduate School of Medicine, Okayama, Japan
| | - Ken-Ei Sada
- Okayama University Graduate School of Medicine, Okayama, and Kochi University, Nankoku, Japan
| | | | - Yuichi Ishikawa
- University of Occupational and Environmental Health Japan, Kitakyushu, and Kanagawa University of Human Services, Kawasaki, Japan
| | - Yuji Yoshioka
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yosuke Kunishita
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | | | - Yohei Kirino
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeru Ohno
- Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Kurita
- Showa University School of Medicine, Tokyo and Fukushima Medical University, Fukushima, and Fukushima Medical University Hospital, Fukushima, Japan
| | - Hideaki Nakajima
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Otto-Meyer S, Prenner J, Mancini AJ. When life imitates data: Failing patients with language barriers. Pediatr Dermatol 2024; 41:759-761. [PMID: 38742640 DOI: 10.1111/pde.15647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Sebastian Otto-Meyer
- Department of Pediatric Dermatology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Joshua Prenner
- Department of Pediatric Dermatology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
- Department of Dermatology, Northwestern Medicine, Chicago, Illinois, USA
| | - Anthony J Mancini
- Department of Pediatric Dermatology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
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Nelis S, Dijkstra HP, Damman OC, Farooq A, Verhagen E. Shared decision-making with athletes: a survey study of healthcare professionals' perspectives. BMJ Open Sport Exerc Med 2024; 10:e001913. [PMID: 38736642 PMCID: PMC11086382 DOI: 10.1136/bmjsem-2024-001913] [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] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives Shared decision-making (SDM) is a trending topic in athlete health care; however, little is known about its use in a sports context. This study aimed to measure knowledge and self-perceived practice of SDM among healthcare professionals working with athletes. This study evaluates SDM attitudes and preferences and explores how healthcare professionals perceive the factors influencing SDM. Methods A web-based cross-sectional survey with open-ended and closed-ended questions. Results Our survey was completed by 131 healthcare professionals. The majority (63.6%) reported to prefer SDM and to be confident in their SDM skills (81.1%). Despite this inclination and confidence, only one in four clinicians reported consistent practice of SDM when feasible. Additionally, most clinicians lacked SDM knowledge. The barriers perceived by healthcare professionals included time constraints (17.6%), limited patient knowledge (17.6%), limited patient motivation (13.5%) and language barriers (16.2%). Importantly, two-thirds of the participants believed that SDM in athlete health care differs from SDM in non-athletes due to the high-pressure environment, the tension between performance and health, and the involvement of multiple stakeholders with potentially conflicting interests. Conclusions Although healthcare professionals preferred SDM, they did not fully understand nor routinely practice it. Most healthcare professionals perceive SDM in athlete health care to differ from SDM in the general population. Therefore, to inform the implementation of SDM in athlete health care, future research is crucial to understand better what makes practising SDM unique in this setting.
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Affiliation(s)
- Sofie Nelis
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Hendrik Paul Dijkstra
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Olga Catherina Damman
- Department of Public and Occupational Health, Amsterdam UMC, Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Abdulaziz Farooq
- FIFA Medical Center for Excellence, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Clemens S, Iglseder B, Alzner R, Kogler M, Rose O, Kutschar P, Krutter S, Kanduth K, Dückelmann C, Flamm M, Pachmayr J. Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study. Age Ageing 2024; 53:afae070. [PMID: 38619121 PMCID: PMC11041409 DOI: 10.1093/ageing/afae070] [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] [Received: 10/13/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. OBJECTIVE to gain in-depth insights into how geriatric patients who have fallen view their medication-related risks of falling and to identify effects and barriers of a CMM in preventing falls. DESIGN complementary mixed-methods pre-post study, based on an embedded quasi-experimental model. SETTING geriatric fracture centre. METHODS qualitative, semi-structured interviews framed the CMM intervention, including a follow-up period of 12 weeks. Interviews explored themes of falling, medication-related risks, post-discharge acceptability and sustainability of interventions using qualitative content analysis. Optimisation of pharmacotherapy was assessed via changes in the weighted and summated Medication Appropriateness Index (MAI) score, number of fall-risk-increasing drugs (FRID) and potentially inappropriate medications (PIM) according to the Fit fOR The Aged and PRISCUS lists using parametric testing. RESULTS thirty community-dwelling patients aged ≥65 years, taking ≥5 drugs and admitted after an injurious fall were recruited. The MAI was significantly reduced, but number of FRID and PIM remained largely unchanged. Many patients were open to medication reduction/discontinuation, but expressed fear when it came to their personal medication. Psychosocial issues and pain increased the number of indications. Safe alternatives for FRID were frequently not available. Psychosocial burden of living alone, fear, lack of supportive care and insomnia increased after discharge. CONCLUSION as patients' individual attitudes towards trauma and medication were not predictable, an individual and longitudinal CMM is required. A standardised approach is not helpful in this population.
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Affiliation(s)
- Stephanie Clemens
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
- Center of Public Health and Health Services Research, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, A-5020, Salzburg, Austria
| | - Reinhard Alzner
- Department of Geriatric Medicine, Christian Doppler Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, A-5020, Salzburg, Austria
| | | | - Olaf Rose
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
| | - Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Simon Krutter
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Karin Kanduth
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
| | - Christina Dückelmann
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
- Landesapotheke Salzburg, Salzburg, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Johanna Pachmayr
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
- Center of Public Health and Health Services Research, Paracelsus Medical University, Salzburg, Austria
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Stoll S, Costello K, Newsome SD, Schmidt H, Sullivan AB, Hendin B. Insights for Healthcare Providers on Shared Decision-Making in Multiple Sclerosis: A Narrative Review. Neurol Ther 2024; 13:21-37. [PMID: 38180727 PMCID: PMC10787702 DOI: 10.1007/s40120-023-00573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
Shared decision-making (SDM) between the patient and their healthcare provider (HCP) in developing treatment plans is increasingly recognized as central to improving treatment adherence and, ultimately, patient outcomes. In multiple sclerosis (MS), SDM is particularly crucial for optimizing treatment in a landscape that has grown more complex with the availability of newer, high-efficacy MS therapies. However, little direct evidence on the effectiveness of SDM is available to guide practice. Multiple factors, including patient age, ethnic background, perceptions, invisible MS symptoms, and psychological comorbidities can influence a patient's willingness and ability to participate in SDM. HCPs need to appreciate these factors and ask the right questions to break down obstacles to SDM. The HCP has a responsibility to help patients feel adequately informed and comfortable in having an active role in their care. This review identifies potential barriers to SDM and provides a strategy for HCPs to overcome these obstacles through patient (and caregiver) discussions to ensure optimal patient satisfaction with treatment and thus the best possible outcomes for their patients.
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Affiliation(s)
| | | | - Scott D Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hollie Schmidt
- Accelerated Cure Project for Multiple Sclerosis, Waltham, MA, USA
| | - Amy B Sullivan
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Barry Hendin
- Integrated Multiple Sclerosis Center, Phoenix, AZ, USA
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Aijaz M, Lewis VA, Murray GF. Advancing equity in challenging times: A qualitative study of telehealth expansion and changing patient-provider relationships in primary care settings during the COVID-19 pandemic. Digit Health 2024; 10:20552076241233148. [PMID: 38434791 PMCID: PMC10906055 DOI: 10.1177/20552076241233148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The patient-provider relationship is critical for achieving high-quality care and better health outcomes. During the COVID-19 pandemic, primary care practices rapidly transitioned to telehealth. While telehealth provided critical access to services for many, not all patients could optimally utilize it, raising concerns about its potential to exacerbate inequities in patient-provider relationships. We investigated technical and workforce-related barriers to accessing telehealth and the impacts on patient-provider relationships for vulnerable populations. Methods Qualitative, semi-structured interviews from May 2021 to August 2021 with 31 individuals (medical directors, physicians, and medical assistants) working at 20 primary care practices in Massachusetts, North Carolina, and Texas. Thematic analysis to better understand how barriers to using telehealth complicated patient-provider relationships. Results Interviewees shared challenges for providers and patients that had a negative effect on patient-provider relationships, particularly for vulnerable patients, including older adults, lower socio-economic status patients, and those with limited English proficiency. Providers faced logistical challenges and disruptions in team-based care, reducing care coordination. Patients experienced technological challenges that made accessing and engaging in telehealth difficult. Interviewees shared challenges for patient-provider relationships as commonly used telephone-only telehealth reduced channels for non-verbal communication. Conclusion This study indicates that barriers to virtual interaction with patients compared to in-person care likely led to weaker personal relationships that may have longer-term effects on engagement with and trust in the healthcare system, particularly among vulnerable patient groups. Additional support and resources should be available to primary care providers to optimize telehealth utilization.
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Affiliation(s)
- Monisa Aijaz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Genevra F Murray
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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Taik FZ, Bensaid R, Adnine A, Mansouri NE, Aharrane FZ, Amar A, Fourtassi M, Abourazzak FE. Use of social media as a source of health information among patients with chronic low back pain. Musculoskeletal Care 2023. [PMID: 38009905 DOI: 10.1002/msc.1846] [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: 11/07/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To evaluate the use of social media (SM) as a source of health information among patients with chronic low back pain (LBP) and to evaluate the factors associated with this use. METHODS This was a cross-sectional study involving patients with chronic LBP. Information on their sociodemographics, LBP characteristics, and comorbidities was collected. With the use of a questionnaire, we evaluated the use of SM as a source of information, examining the frequency of use, the type of SM used, and degree of confidence and application of information found. Catastrophising, trust in physicians, and concerns regarding medicines were assessed through the Pain Catastrophizing Scale (PCS), Trust in Physician Scale (TPS) and Beliefs about Medicines Questionnaire (BMQ Specific Concerns). A regression analysis was conducted to identify factors associated with the use of SM. RESULTS A total of 118 patients were included. The mean age was 53.01 ± 14.09 years. Of the sample, 68.6% sought information regarding their LBP on social networks. The main source was YouTube (30%). Eighteen point six percent of patients trusted the information found through SM, and 16.1% have already acted on some of this information. The majority of patients (82%) would prefer to have healthcare professionals in their virtual spaces to answer their questions. In a multivariate analysis, only the degree of trust in the physician was negatively associated with SM use (OR = 0.95 IC 95% [0.91-0.99]; p = 0.03). CONCLUSION This survey showed that a proportion of patients suffering from chronic LBP use SM, YouTube in particular, as a source of health information. The level of trust in physicians was the strongest factor that impelled people to use SM as a source of health information.
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Affiliation(s)
- Fatima Zahrae Taik
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Rajaa Bensaid
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
| | - Anass Adnine
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - Noema El Mansouri
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
| | | | - Amine Amar
- Applied Mathematics and Data Science, School of Science and Engineering, Al Akhawayn University, Ifrane, Morocco
| | - Maryam Fourtassi
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
- Physical Medicine and Rehabilitation Department, Mohammed VI University Hospital, Tangier, Morocco
| | - Fatima Ezzahra Abourazzak
- Department of Rheumatology, Mohammed VI University Hospital, Tangier, Morocco
- Life and Health Sciences Laboratory, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
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Burghall A, Ruhl M, Rosaasen N, Groot B, Flood K, Davis K, Minakakis N, Wichart J, Mansell H. A scoping review of pediatric transplant education. Pediatr Transplant 2023; 27:e14578. [PMID: 37528694 DOI: 10.1111/petr.14578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Education is crucial for pediatric patients and caregivers throughout the transplant continuum, yet data are lacking around which interventions are effective and in what circumstances. METHODS We undertook a scoping review with the objectives of (a) describing the types, effects, and outcomes of patient-focused educational interventions before and after pediatric transplant and (b) understanding the educational experiences of patients and caregivers. Five scientific databases were explored for relevant literature using the JBI methodology. Educational interventions published in English, targeting pediatric solid organ transplant patients (0-25 years) and their caregivers were included. Relevant data from eligible articles (n = 27) were extracted and summarized. RESULTS Eighteen articles describing 17 educational interventions were identified for objective A, and nine articles qualitatively assessing patient or parental learning needs were identified for objective B. Most interventions were directed toward teenage patients and their caregivers post kidney transplant, primarily focusing on medication self-management and adherence, or providing general information on transplant using multicomponent delivery formats. Most interventions achieved statistically significant improvements in knowledge (n = 8/9) and patients or caregivers expressed satisfaction with the intervention (n = 7/7) but health-related outcomes such as medication adherence (n = 2/6) or behavior change (n = 1/3) rarely achieved statistically significant results. In objective B, patients and caregivers described the transplant process as overwhelming, but indicated that social supports and education helped them cope. Participants consistently wanted more information than they received. CONCLUSION Caregivers and pediatric patients value transplant education, but high-quality studies are limited. Since education is a fundamental part of the transplant process, future research in this area should be prioritized.
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Affiliation(s)
- Ashley Burghall
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michelle Ruhl
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nicola Rosaasen
- Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- Canadian Donation and Transplantation Research Program, Canada
| | - Brianna Groot
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kayla Flood
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Keefe Davis
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Jenny Wichart
- Canadian Donation and Transplantation Research Program, Canada
- Department of Pharmacy, Alberta Health Services, Edmonton, Alberta, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Donation and Transplantation Research Program, Canada
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12
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Stajszczyk M, Świerkowska G, Smolik K, Domysławska I, Charkiewicz K, Samborski W. The perspective of Polish patients with rheumatoid arthritis - treatment expectations, patient-reported outcomes, and digital literacy (the SENSE study). Reumatologia 2023; 61:331-338. [PMID: 37970121 PMCID: PMC10634413 DOI: 10.5114/reum/171625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/28/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction A widely accepted treat-to-target strategy for rheumatoid arthritis (RA) requires the patient's perspective in making treatment decisions. However, data on treatment preferences and expectations of Polish patients with RA are scarce. The aim of the study was to determine the satisfaction with treatment and the nature of therapeutic preferences and expectations of Polish patients with moderate to severe RA. Material and methods Fifty-two adult Polish patients with moderately to highly active RA were asked to complete patient-reported outcomes and patient-provided information questionnaires. Additionally, patient sociodemographic and clinical data and information on patient current and planned treatment strategies were collected. Results The mean global assessment of patient satisfaction with treatment was 64.1 ±24.6, below the level of indicating satisfaction. Rheumatoid arthritis negatively impacted patients' lives, resulting in a 37.8% impairment of work efficiency and 45% impairment of total activity. Primary treatment expectations for patients were lasting relief of RA symptoms, reduced pain and swelling in joints, increased flexibility of joints, and general improvement of arthritis. The most acceptable potential side effect was weight gain and the least acceptable were increases in the risk of cardiovascular disease, infection, and malignancies. The rapid onset of the drug effect (up to 1 week) was a preference of 48.1% of patients. Access to internet health resources was important for 44.2% of patients, but the median total eHealth literacy score in the study population was 24.0 (interquartile range: 20.5-28.0, range 8-37), which means low digital health literacy (DHL). Conclusions Understanding these treatment preferences and expectations of patients with RA is essential for clinical practitioners to facilitate shared treatment decision-making. Digital health literacy data suggest the need of further improvement.
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Affiliation(s)
- Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Center for Rheumatology, Orthopedics and Rehabilitation, Ustron, Poland
| | - Grażyna Świerkowska
- Division of Rheumatology, Provincial Multispecialist Center of Oncology and Traumatology – N. Copernicus Memorial Hospital in Lodz, Poland
| | | | - Izabela Domysławska
- Formerly: Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Poland
| | | | - Włodzimierz Samborski
- Department of Rheumatology, Rehabilitation and Internal Medicine, University of Medical Sciences, Poznan, Poland
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13
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Somohano VC, Smith CL, Saha S, McPherson S, Morasco BJ, Ono SS, Zaccari B, Lovejoy J, Lovejoy T. Patient-Provider Shared Decision-Making, Trust, and Opioid Misuse Among US Veterans Prescribed Long-Term Opioid Therapy for Chronic Pain. J Gen Intern Med 2023; 38:2755-2760. [PMID: 37118560 PMCID: PMC10506962 DOI: 10.1007/s11606-023-08212-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Patient-provider shared decision-making is associated with better treatment adherence and pain outcomes in opioid-specific pain management. One possible mechanism through which shared decision-making may impact pain management outcomes is trust in one's prescribing provider. Elucidating relationships between factors that enhance the patient-provider relationship, such as shared decision-making and trust, may reduce risks associated with opioid treatment, such as opioid misuse. OBJECTIVE The purpose of this study was to investigate the mediating effect of trust in one's prescribing provider on the relationship between shared decision-making and current opioid misuse. DESIGN A secondary analysis of data from a prospective cohort study of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. PARTICIPANTS Eligibility criteria included being prescribed LTOT, ability to speak and read English, and access to a telephone. Veterans were excluded if they had a cancer diagnosis, received opioid agonist therapy for opioid use disorder, or evidence of pending discontinuation of LTOT. Stratified random sampling was employed to oversample racial and ethnic minorities and women veterans. MAIN MEASURES Physician Participatory Decision-Making assessed level of patient involvement in medical decision-making, the Trust in Provider Scale assessed interpersonal trust in patient-provider relationships, and the Current Opioid Misuse Measure assessed opioid misuse. KEY RESULTS Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator (c = - 0.243, p < 0.001), such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant (c' = - 0.147, p = 0.007). CONCLUSIONS Shared decision-making is associated with less prescription opioid misuse through the trust that is fostered between patients and providers.
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Affiliation(s)
- Vanessa C Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Crystal L Smith
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Belle Zaccari
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Jennette Lovejoy
- Department of Communication Studies, University of Portland, Portland, OR, USA
| | - Travis Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
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14
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Brown M, Páez YD, Jabri A, Weiner J, Allen A, Sydnor-Campbell T, Fritz S, Creasman M, Kasturi S, Safford MM, Navarro-Millán I. Virtual training of rheumatoid arthritis peer coaches in motivational interviewing skills and concepts of cardiovascular disease. Contemp Clin Trials Commun 2023; 33:101130. [PMID: 37122490 PMCID: PMC10130077 DOI: 10.1016/j.conctc.2023.101130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Background Peer coaching interventions are effective in helping individuals with chronic conditions understand their disease. Most peer coach training programs occur in person, which has become an obstacle during the COVID pandemic. We describe our experiences with virtual training for future peer coach interventions. Methods Individuals with rheumatoid arthritis (RA) between 40 and 75 years of age were recruited and interviewed by the research team. We conducted seven virtual training sessions focused on four main points: Listen, Discuss, Practice, and Certify. The peer coaches provided feedback throughout the program, which was used to refine the training and intervention. A post-training focus group assessed satisfaction with the training program and intervention development process. Results Four peer coaches (3 women, 1 man) were trained, including 2 Black and 2 White individuals with advanced degrees. Their ages ranged from 52 to 57, and their RA duration ranged from 5 to 15 years. An iterative process with the coaches and researchers resulted in a nine-week training program. Peer coaches reported satisfaction, confidence, and a preference for the virtual training format. Conclusion This virtual peer coach training program was feasible and acceptable for coaches with advanced degrees during the global COVID-19 pandemic. Our approach represents an opportunity to adapt training that has been traditionally done in person. By doing so, our approach facilitates the recruitment and training of a diverse group of coaches and promotes sustainability.
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Affiliation(s)
- Mackenzie Brown
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
| | | | - Assem Jabri
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
| | - Joan Weiner
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
- Patient Power Research Network-ArthritisPower, USA
| | - Aberdeen Allen
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
- Patient Power Research Network-ArthritisPower, USA
| | - Tien Sydnor-Campbell
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
- Patient Power Research Network-ArthritisPower, USA
| | - Shelley Fritz
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
- Patient Power Research Network-ArthritisPower, USA
| | - Megan Creasman
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
- NewYork-Presbyterian Hospital-Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
| | | | - Monika M. Safford
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
| | - Iris Navarro-Millán
- Weill Cornell Medicine, Division of General Internal Medicine, New York, NY, USA
- Hospital for Special Surgery, Division of Rheumatology, New York, NY, USA
- Corresponding author. Weill Cornell Medicine, Division of General Internal Medicine Hospital for Special Surgery, Division of Rheumatology, 420 E 70th St., LH-363, New York, NY, 10021, USA.
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15
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Barton JL, Markwardt S, Niederhausen M, Schue A, Dougherty J, Katz P, Saha S, Yelin EH. Are We on the Same Page? A Cross-Sectional Study of Patient-Clinician Goal Concordance in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:625-633. [PMID: 34569172 PMCID: PMC8957637 DOI: 10.1002/acr.24794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient-clinician goal concordance is associated with improved outcomes in certain chronic diseases but not explored in rheumatoid arthritis (RA). We examined goal concordance, correlates of concordance, and the association of concordance with health outcomes. METHODS Adult patients with RA seen at least 1 time in the prior 12 months at 1 of 2 rheumatology clinics participated. Patients and their clinicians independently ranked top 3 goals for RA treatment from 8 options before a routine visit. Patients completed postvisit surveys on health, demographic information, health literacy, and adherence. Goal concordance was defined as the patient's number 1 goal being among the clinician's top 3 goals for that patient. Bivariable and multivariable logistic regression models were used to examine correlates of concordance. RESULTS Patients were 58% female and 16% Spanish-speaking, and 29% had limited health literacy. Among 204 patient-clinician dyads, 20% were goal-discordant. "Have less pain" was selected by both patient and clinician in 81% of dyads, followed by "have fewer problems doing daily activities" by 63%. Otherwise, clinicians prioritized avoiding side effects, whereas patients ranked improved sleep, fatigue, and mood. Longer disease duration was associated with discordance (median 13.3 years, interquartile range [IQR] 5.2-20 among discordant vs. 7 years, IQR 4-14; P = 0.039); higher depressive symptoms were associated with concordance (8.1% vs. 24%; P = 0.04). Goal concordance was associated with higher medication adherence (adjusted odds ratio 2.76 [95% confidence interval 1.01, 7.56]). CONCLUSION One in 5 patient-clinician dyads had discordant treatment goals. Goal concordance was associated with higher medication adherence. Studies to improve goal elicitation and communication of patients with RA's priorities are needed.
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Affiliation(s)
- Jennifer L. Barton
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
| | | | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
| | - Allison Schue
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
| | - Jacob Dougherty
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
| | - Patricia Katz
- University of California, San Francisco, San Francisco, CA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
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16
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Baker R, Mantilla B, Graf J, Katz PP, Goglin S, Barton JL, Liew JW, Wysham KD. Racial and Ethnic Differences in a Biochemical Marker of Rheumatoid Arthritis Disease Activity. ACR Open Rheumatol 2023; 5:142-148. [PMID: 36754575 PMCID: PMC10010485 DOI: 10.1002/acr2.11524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE Racial and ethnic disparities in rheumatoid arthritis (RA) disease activity measures have been documented. We compared racial and ethnic differences in disease activity using multiple composite measures, including an objective measure, the multi-biochemical disease activity (MBDA) score. METHODS Data are derived from the University of California, San Francisco RA Cohort, a longitudinal observational cohort. Participants with at least one MBDA measure and self-reported race and ethnicity were included. Multivariable linear regression evaluated the association between race and ethnicity groups and mean MBDA score, adjusting for potential confounders, including symptom duration and medication use. Sensitivity analyses substituted the Clinical Disease Activity Index (CDAI) and the Disease Activity Score-28 joints with erythrocyte sedimentation rate (DAS28-ESR) for the MBDA in multivariable models. RESULTS We included 267 participants (86% female, mean age 52.7 ± 13.3 years). The majority were Latinx (n = 137; 51%), followed by Asian (n = 91; 34%). After adjustment, Latinx participants had the highest mean MBDA score (40.6 ± 2.1) compared with White participants at (32.8 ± 6.7). Black participants had the second highest mean MBDA score, followed by Asian participants (36.3 ± 5.3, 36.0 ± 2.7, respectively), although neither were significantly different from White participants. The trends observed for the CDAI and DAS28-ESR were similar to those for the MBDA. CONCLUSION We found significantly higher disease activity measured by the MBDA and DAS28-ESR in Latinx participants compared with White participants. We also found significantly higher disease activity in Asian participants compared with White participants with the DAS28-ESR. Our findings, although limited by the small number of White participants in the referent group, suggest that RA disease activity measures may be influenced by external factors that have differential impacts by racial and ethnic group.
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Affiliation(s)
- Rahaf Baker
- Alameda Health System Internal Medicine Residency, Oakland, California
| | | | | | | | | | - Jennifer L Barton
- Oregon Health and Sciences University and VA Portland Health Care System, Oregon, Portland
| | - Jean W Liew
- Boston University School of Medicine, Boston, Massachusetts
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17
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Zhuang M, Li CC, Chen SY, Tu XH, Liu L, Chen XL, Xu CW, Wang J. Development and validation of a Systemic Sclerosis Health Literacy Scale. Front Public Health 2023; 11:1038019. [PMID: 36908416 PMCID: PMC9996225 DOI: 10.3389/fpubh.2023.1038019] [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: 09/06/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Background and aim Health literacy levels are strongly associated with clinical outcomes and quality of life in patients with chronic diseases, and patients with limited health literacy often require more medical care and achieve poorer clinical outcomes. Among the large number of studies on health literacy, few studies have focused on the health literacy of people with systemic sclerosis (SSc), and there is no specific tool to measure health literacy in this group. Therefore, this study plans to develop a health literacy scale for patients with SSc. Methods This study included 428 SSc patients from the outpatient and inpatient departments of the Department of Rheumatology and Immunology, the first affiliated Hospital of Anhui Medical University and the first affiliated Hospital of University of Science and Technology of China. The formulation of the scale was completed by forming the concept of health literacy of SSc patients, establishing the item pool, screening items, and evaluating reliability and validity. Classical measurement theory was used to screen items, factor analysis was used to explore the construct validity of the scale, and Cronbach's alpha coefficient was used to assess the internal consistency. Results Our study population was predominantly middle-aged women, with a male to female ratio of 1:5.7 and a mean age of 51.57 ± 10.99. A SSc Health Literacy scale with 6 dimensions and 30 items was developed. The six dimensions are clinic ability, judgment/evaluation information ability, access to information ability, social support, treatment compliance and application information ability. The Cronbach's alpha coefficient of the scale is 0.960, retest reliability is 0.898, split-half reliability is 0.953, content validity is 0.983, which has good reliability and validity. Conclusion The Systemic Sclerosis Health Literacy Scale may become a valid tool to evaluate the health literacy level of patients with SSc.
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Affiliation(s)
- Meng Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Cheng-Cheng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Shan-Yu Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin-Hua Tu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Lian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Xi-Lai Chen
- Department of Statistics, College of Statistics and Applied Mathematics, Anhui University of Finance and Economics, Bengbu, China
| | - Cheng-Wei Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Medical Data Processing Center, Anhui Medical University, Hefei, China
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18
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Duarte C, Kvien TK, Sexton J, Santos E, de Wit M, Gossec L, da Silva JAP. Patient Experienced Symptom State in rheumatoid arthritis: sensitivity to change in disease activity and impact. Rheumatology (Oxford) 2022; 62:98-107. [PMID: 35482485 DOI: 10.1093/rheumatology/keac257] [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: 01/22/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The Patient Experienced Symptom State (PESS) is a single-question, patient-reported outcome that is validated to assess global disease impact in RA. This study addresses its sensitivity to change, and reliability. METHODS Disease activity, disease impact in the seven domains of RA Impact of Disease (RAID) and PESS were assessed in patients with RA from the NOR-DMARD registry, at two visits, 6 months apart. The PESS over the last week was scored at five levels, from 'very bad' to 'very good'. Disease impact and disease activity were compared between patients who improved, maintained or worsened PESS over time, through one-way analysis of variance, with post hoc Bonferroni correction. Correlations between changes in these parameters were assessed through Spearman's correlation coefficient. Sensitivity to change was assessed by standardized response mean (SRM) between the two visits. Reliability was analysed through intraclass correlation coefficient (ICC) between the two visits in patients with stable disease activity and impact. RESULTS In 353 patients [76.8% females, mean (s.d.) 9.9 (9.6) years disease duration], improvement in PESS level was associated with substantial improvements in mean impact in all domains as well as disease activity (P <0.02). PESS change was moderately to strongly correlated with RAID domains and disease activity (rho: 0.4-0.7). PESS was responsive to change (SRM: 0.65, 95% CI: 0.54, 0.76), particularly among RAID responders (SRM: 1.79, 95% CI: 1.54, 1.99). PESS was moderately reliable in patients with stable condition (ICC: 0.72, 95% CI: 0.52, 0.83). CONCLUSION PESS is valid, feasible, reliable and responsive, representing an opportunity to improve the assessment of disease impact with minimal questionnaire burden.
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Affiliation(s)
- Catiá Duarte
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra.,Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joe Sexton
- Department of Rheumatology, Diakonhjemmet Hospital
| | - Eduardo Santos
- Viseu Higher School of Health, Viseu.,Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | | | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM.,Rheumatology Department, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Jose A P da Silva
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra.,Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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19
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Himmelstein J, Cai C, Himmelstein DU, Woolhandler S, Bor DH, Dickman SL, McCormick D. Specialty Care Utilization Among Adults with Limited English Proficiency. J Gen Intern Med 2022; 37:4130-4136. [PMID: 35349026 PMCID: PMC9708984 DOI: 10.1007/s11606-022-07477-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/03/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with limited English proficiency (LEP) face greater barriers to accessing medical care than those who are English proficient (EP). Language-related differences in the use of outpatient care across the full spectrum of physician specialties have not been studied. OBJECTIVE To compare outpatient visit rates to physicians in 28 specialties by people with LEP vs EP. DESIGN Multivariable negative binomial regression analysis of nationally representative data from the Medical Expenditure Panel Survey (pooled 2013-2018) with adjustment for age, sex, and self-reported health status. PARTICIPANTS 149,611 survey respondents aged 18 and older. EXPOSURE LEP, defined as taking the survey in a language other than English. MAIN MEASURES Annual per capita adjusted visit rate ratios (ARRs) comparing visit rates by LEP and EP persons to individual specialties, and to three categories of specialties: (1) primary care (internal or family medicine, geriatrics, general practice, or obstetrics/gynecology), (2) medical-subspecialties, or (3) surgical specialties. KEY RESULTS Patients with LEP were underrepresented in 26 of 28 specialties. Disparities were particularly large for the following: pulmonology (ARR, 0.26; 95% CI, 0.20-0.35), orthopedics (ARR, 0.35; 95% CI, 0.30-0.40), otolaryngology (ARR, 0.40; 95% CI, 0.27-0.59), and psychiatry (ARR, 0.43; 95% CI, 0.32-0.58). Among individuals with several specific common chronic conditions, LEP-EP disparities in visits to specialties in those conditions generally persisted. Disparities were larger for medical subspecialties (ARR, 0.41; 95% CI, 0.36-0.46) and surgical specialties (ARR, 0.46; 95% CI, 0.42-0.50) than for primary care (ARR, 0.76; 95% CI, 0.72 to 0.79). CONCLUSIONS Patients with LEP are underrepresented in most outpatient specialty practices, particularly medical subspecialties and surgical specialties. Our findings highlight the need to remove language barriers to physician services in order to ensure access to the full spectrum of outpatient specialty care for people with LEP.
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Affiliation(s)
- Jessica Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Christopher Cai
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David U Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- City University of New York at Hunter College, New York, NY, USA
| | - Steffie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- City University of New York at Hunter College, New York, NY, USA
| | - David H Bor
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Samuel L Dickman
- Planned Parenthood South Texas, San Antonio, TX, USA
- The University of Texas at Austin, Austin, TX, USA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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Berkovic D, Ayton D, Briggs AM, Ademi Z, Ackerman IN. Personal healthcare costs borne by younger people living with arthritis in Australia: An exploratory observational study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2540-e2548. [PMID: 34957623 DOI: 10.1111/hsc.13697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
Arthritis is a long-term musculoskeletal disease, requiring ongoing management. However, the financial burden of managing arthritis is under-explored and is yet to be quantified from the perspective of individuals with the condition. Using an exploratory observational design, this study aimed to quantify arthritis-related costs borne by a sample of working-age adults aged 18-50 years who responded to the study advertisement. Participants completed a weekly cost diary for 6 weeks, detailing their personal non-reimbursed (out-of-pocket) arthritis-related costs. Financial distress was measured using the InCharge Financial Distress/Financial Well-Being Scale. Costs data were analysed descriptively. Mann-Whitney U tests were used to examine relationships between residential location or employment status and out-of-pocket costs. Linear regression and Spearman's rho were used to estimate relationships between age or years since diagnosis and out-of-pocket costs, and between out-of-pocket costs and financial distress respectively. Sixteen adults (median age 40 years, 100% female) with a range of arthritis conditions (median (IQR): 8 (7.5) years since diagnosis) including rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and ankylosing spondylitis completed the six-week cost diary. All participants reported out-of-pocket expenditure related to arthritis. The median per-person expenditure across the 6 weeks was AUD 1635. The highest reported costs per participant across the 6 weeks were for medical expenses (median AUD 197) and allied health appointments (median AUD 190). In total, the cohort spent AUD 15,272 across the study period. Perceived financial distress was high: median (IQR) financial distress 7 (2.25) on a 1 (lowest) to 10 (highest) scale. Positive relationships between age and costs, and between costs and financial distress were identified. These findings help us understand fiscal expenditure and related distress relevant to younger individuals with arthritis, and can be used to raise awareness of their financial concerns.
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Affiliation(s)
- Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Levic M, Bogavac-Stanojevic N, Krajnovic D. Cross-Cultural Adaptation and Validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL-SR) for Diabetic Patients in Serbia. Healthcare (Basel) 2022; 10:healthcare10091667. [PMID: 36141279 PMCID: PMC9498457 DOI: 10.3390/healthcare10091667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Thoroughly validated instruments can provide a more accurate and reliable picture of how the instrument works and of the level of health literacy in people with type 2 diabetes mellitus (T2DM). The present work aimed at cross-cultural adaptation and validation of the Functional, Communicative and Critical Health Literacy Instrument (FCCHL) in patients with T2DM in Serbia. After translation and back-translation, views from an expert group, one cognitive interview study (n = 10) and one survey study (n = 130) were conducted among samples of diabetic patients. Item analysis, internal consistency, content validity, confirmatory factor analysis (CFA) and reliability testing were performed. When all 14 items were analyzed, loading factors were above 0.55, but without adequate model fit. After removing two items with the lowest loadings FHL1 and IHL2 the fit indexes indicated a reasonable normed χ2 (SB scaled χ2/df = 1.90). CFI was 0.916 with SRMR = 0.0676 and RMSEA = 0.0831. To determine internal consistency, Cronbach’s alpha coefficient was 0.796 for the whole FCCHL-SR12. With only minor modifications compared to the English version, the 12-item FCCHL instrument is valid and reliable and can be used to measure health literacy among Serbian diabetic patients. However, future research on a larger population in Serbia is necessary for measuring the levels of HL and their relationship with other determinants in this country.
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Affiliation(s)
- Marija Levic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade 11221, Serbia
| | - Natasa Bogavac-Stanojevic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade 11221, Serbia
| | - Dusanka Krajnovic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade 11221, Serbia
- Correspondence:
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Mertz K, Eppler S, Shah RF, Yao J, Steffner R, Safran M, Hu S, Chou L, Amanatullah DF, Kamal RN. Health Literacy and Patient Participation in Shared Decision-Making in Orthopedic Surgery. Orthopedics 2022; 45:227-232. [PMID: 35394383 DOI: 10.3928/01477447-20220401-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The influence of health literacy on involvement in decision-making in orthopedic surgery has not been analyzed and could inform processes to engage patients. The goal of this study was to determine the relationship between health literacy and the patient's preferred involvement in decision-making. We conducted a cross-sectional observational study of patients presenting to a multispecialty orthopedic clinic. Patients completed the Literacy in Musculoskeletal Problems (LiMP) survey to evaluate their health literacy and the Control Preferences Scale (CPS) survey to evaluate their preferred level of involvement in decision-making. Statistical analysis was performed with Pearson's correlation and multivariable logistic regression. Thirty-seven percent of patients had limited health literacy (LiMP score <6). Forty-eight percent of patients preferred to share decision-making with their physician equally (CPS score=3), whereas 38% preferred to have a more active role in decision-making (CPS score≤2). There was no statistically significant correlation between health literacy and patient preference for involvement in decision-making (r=0.130; P=.150). Among patients with orthopedic conditions, there is no significant relationship between health literacy and preferred involvement in decision-making. Results from studies in other specialties that suggest that limited health literacy is associated with a preference for less involvement in decision-making are not generalizable to orthopedic surgery. Efforts to engage patients to be informed and participatory in decision-making through the use of decision aids and preference elicitation tools should be directed toward variation in preference for involvement in decision-making, but not toward patient health literacy. [Orthopedics. 2022;45(4):227-232.].
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Herrler A, Hoffmann DU, Görig T, Georg S, König J, Urschitz MS, De Bock F, Eichinger M. Assessing the extent of shared decision making in Pediatrics: Preliminary psychometric evaluation of the German CollaboRATE pediatric scales for patients aged 7-18 years, parents and parent-proxy reports. PATIENT EDUCATION AND COUNSELING 2022; 105:1642-1651. [PMID: 34865889 DOI: 10.1016/j.pec.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/10/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To conduct a preliminary evaluation of psychometric properties of CollaboRATEpediatric, a set of three scales to assess shared decision making (SDM) with pediatric patients, parents and parents on behalf of their children (parent-proxy reports). As secondary objectives we examined the scales' distributional characteristics, acceptability, and agreement between scales. METHODS Patients aged ≥ 7 years and parents were recruited in two outpatient facilities providing healthcare services for children with neurological and behavioral health conditions. We collected 46, 169 and 227 pediatric patient, parent-proxy and parent reports, respectively. Convergent, divergent and discriminative validity were investigated. Acceptability of the scales and agreement between patient and parent-proxy reports were explored by assessing item nonresponse and Bland-Altman plots. RESULTS While convergent and divergent validity were established for the parent scale, discriminative validity was not demonstrated for any of the scales. The scales showed good to excellent acceptability. Parent-proxy reports agreed to a moderate extent with patients' self-reports of SDM. CONCLUSION CollaboRATEpediatric offers a starting point for parsimoniously assessing SDM in Pediatrics, however further psychometric testing is warranted. PRACTICE IMPLICATIONS Given limited psychometric support for the pediatric patient scale, we recommend using both the pediatric patient and parent-proxy report scales to assess SDM in pediatric patients until further psychometric testing is concluded.
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Affiliation(s)
- Angélique Herrler
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW - Gerontological Research on Well-being, University of Cologne, Cologne, Germany
| | - Dorle U Hoffmann
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tatiana Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Georg
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jochem König
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael S Urschitz
- Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Freia De Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Federal Centre of Health Education, Cologne, Germany
| | - Michael Eichinger
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Morrison T, Foster E, Dougherty J, Barton J. Shared Decision Making in Rheumatology: A Scoping Review. Semin Arthritis Rheum 2022; 56:152041. [DOI: 10.1016/j.semarthrit.2022.152041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
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Keij SM, de Boer JE, Stiggelbout AM, Bruine de Bruin W, Peters E, Moaddine S, Kunneman M, Pieterse AH. How are patient-related characteristics associated with shared decision-making about treatment? A scoping review of quantitative studies. BMJ Open 2022; 12:e057293. [PMID: 35613791 PMCID: PMC9174801 DOI: 10.1136/bmjopen-2021-057293] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To identify what patient-related characteristics have been reported to be associated with the occurrence of shared decision-making (SDM) about treatment. DESIGN Scoping review. ELIGIBILITY CRITERIA Peer-reviewed articles in English or Dutch reporting on associations between patient-related characteristics and the occurrence of SDM for actual treatment decisions. INFORMATION SOURCES COCHRANE Library, Embase, MEDLINE, PsycInfo, PubMed and Web of Science were systematically searched for articles published until 25 March 2019. RESULTS The search yielded 5289 hits of which 53 were retained. Multiple categories of patient characteristics were identified: (1) sociodemographic characteristics (eg, gender), (2) general health and clinical characteristics (eg, symptom severity), (3) psychological characteristics and coping with illness (eg, self-efficacy) and (4) SDM style or preference. Many characteristics showed no association or unclear relationships with SDM occurrence. For example, for female gender positive, negative and, most frequently, non-significant associations were seen. CONCLUSIONS A large variety of patient-related characteristics have been studied, but for many the association with SDM occurrence remains unclear. The results will caution often-made assumptions about associations and provide an important step to target effective interventions to foster SDM with all patients.
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Affiliation(s)
- Sascha M Keij
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Joyce E de Boer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Wändi Bruine de Bruin
- Schaeffer Center for Health Policy and Economics, Dornsife Department of Psychology, and Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Ellen Peters
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, Oregon, USA
| | - Saïda Moaddine
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Marleen Kunneman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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Morris NS, Nnaji C, Sarkis M. "Was Test Designed for Africans?" Health Literacy and African Immigrants. J Racial Ethn Health Disparities 2022; 9:315-324. [PMID: 33428160 DOI: 10.1007/s40615-020-00959-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Immigrants experience barriers to accessing and utilizing health care. Language and cultural differences regarding health and healing impact use of health care. Limited health literacy is associated with decreased preventive health services and is reported among immigrant groups in the USA, but the health literacy of African immigrants is not known. OBJECTIVE Assess health literacy, its association with engagement in primary care and select sociodemographic variables, and the use of two health literacy measures with African immigrants. METHODS We conducted a community-based participatory research cross-sectional survey among African immigrants in Massachusetts. Participants completed the Newest Vital Sign, the Health Literacy Skills Instrument, acceptability questionnaires, and a Health Survey. We observed and recorded comments and questions as participants completed the surveys. KEY RESULTS Out of 75 participants, 60% have limited health literacy. Over 80% are connected to a health care system and comfortable speaking with their doctor/nurse. Education, English proficiency, country of origin, and access to health care are associated with health literacy. Participants found the measures easy to understand but difficult to answer. Observation data revealed unfamiliarity with nutrition labels, cooking measurements, and navigation of internet links, and the need for clarification of select items. CONCLUSIONS Most African immigrants in this study have limited health literacy despite English proficiency, college education, employment, and connection to a health system. Further research is needed to determine the value of aligning the measurement of health literacy with the cultural-linguistic identities of the population being assessed versus the need to understand their health literacy within the dominant culture.
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Affiliation(s)
- Nancy S Morris
- University of Massachusetts Medical School Graduate School of Nursing, S1-853, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Chioma Nnaji
- Multicultural AIDS Coalition (MAC), Boston, MA, USA
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27
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Kahler J, Mastarone G, Matsumoto R, ZuZero D, Dougherty J, Barton JL. "It may help you to know…": The Early-phase Qualitative Development of a Rheumatoid Arthritis Goal Elicitation Tool. J Rheumatol Suppl 2022; 49:142-149. [PMID: 34210836 PMCID: PMC8720108 DOI: 10.3899/jrheum.201615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making, which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians. METHODS Tool development occurred in 3 phases: (1) clinician feedback on the initial prototype during a communication training session; (2) semistructured interviews with RA patients; and (3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool. RESULTS Clinicians (n = 15) and patients (n = 10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool deemphasizing goals outside of their perceived treatment domain or available resources; they highlighted the benefits of the tool to facilitate conversation but raised concerns regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and preparing for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve. CONCLUSION A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher-quality care in RA.
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Affiliation(s)
- Julie Kahler
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | | | - Rachel Matsumoto
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | - Danielle ZuZero
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Jacob Dougherty
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | - Jennifer L. Barton
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA,Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
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Gutman CK, Lion KC, Fisher CL, Aronson PL, Patterson M, Fernandez R. Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care. J Am Coll Emerg Physicians Open 2022; 3:e12639. [PMID: 35072163 PMCID: PMC8759339 DOI: 10.1002/emp2.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023] Open
Abstract
Individuals with limited English proficiency (LEP) are at high risk for adverse outcomes in the US health care system. This is particularly true for patients with LEP seeking care in the emergency department (ED). Although professional language interpretation improves the quality of care for these patients, it remains underused. The dynamic, discontinuous nature of an ED visit poses distinct challenges and opportunities for providing equitable, high-quality care for patients with LEP. Evidence-based best practices for identifying patients with LEP and using professional interpretation are well described but inadequately implemented. There are few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP. There is an urgent need for high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
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Affiliation(s)
- Colleen K. Gutman
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - K. Casey Lion
- Department of PediatricsUniversity of Washington School of MedicineSeattle, WashingtonUSA
- Center for Child Health, Behavior, and DevelopmentSeattle Children's Research InstituteSeattle, WashingtonUSA
| | - Carla L. Fisher
- STEM Translational Communication CenterUniversity of Florida College of Journalism and CommunicationGainesvilleFloridaUSA
- UF Health Cancer Center, Center for Arts in MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Paul L. Aronson
- Department of PediatricsYale School of MedicineNew HavenConnecticutUSA
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Mary Patterson
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
- Center for Experiential Learning and SimulationUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Rosemarie Fernandez
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
- Center for Experiential Learning and SimulationUniversity of Florida College of MedicineGainesvilleFloridaUSA
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van Rossenberg LX, Ring D, Jacobs X, Sulkers G, van Heijl M, van Hoorn BT. Patient Perceived Involvement in Their Treatment is Influenced by Factors Other Than Independently Rated Clinician Communication Effectiveness. J Patient Exp 2021; 8:23743735211065261. [PMID: 34901411 PMCID: PMC8664301 DOI: 10.1177/23743735211065261] [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] [Indexed: 11/17/2022] Open
Abstract
We analyzed (1) the correspondence of patient and clinician perceived patient involvement in decision making and ratings made by independent observer's independent ratings, as well as (2), factors associated with patient-perceived involvement, among patients seeking hand specialty care. During 63 visits, the patient, their hand specialist, and 2 independent observers each rated patient involvement in decision making using the 9-item shared decision-making questionnaire for patients and clinicians, and the 5-item observing patient involvement scale (OPTION-5). We also measured health literacy (Newest Vital Sign), patient and visit characteristics (gender, age, race, years of education, occupation, marital status, and family present). There was no correlation (ρ = 0.17; P = .17) between patient (median 42, IQR 36-44.5) and clinician (38, IQR 35-43) ratings of patient involvement in decision making. Independently rated patient involvement correlated moderately with a specialist (ρ = 0.35, P <.01), but not patient (ρ = 0.22, P = .08) ratings. The finding that patient perception of their involvement in decision making has little or no relationship to independently rated clinician communication effectiveness and effort, suggests that other aspects of the encounter-such as empathy and trust-may merit investigation as mediators of the patient agency.
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Affiliation(s)
- Luke X van Rossenberg
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Xander Jacobs
- Department of Plastic Surgery, Hand Service, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - George Sulkers
- Department of Plastic Surgery, Hand Service, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| | - Bastiaan T van Hoorn
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
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Levic M, Bogavac-Stanojevic N, Krajnovic D. The Instruments Used to Assess Health Literacy and Pharmacotherapy Literacy of Diabetes Mellitus Type 2 Patients: A Scoping Review. Front Public Health 2021; 9:747807. [PMID: 34646807 PMCID: PMC8502961 DOI: 10.3389/fpubh.2021.747807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with chronic diseases, like diabetes need to continuously perform tasks associated with self-management especially with medications they use. It is shown that the patients with diabetes with limited HL and PTHL cannot read medication labels correctly, may misuse their medications, spend much more on therapy and generally have difficulties in understanding printed care instructions and perceiving health advice and warnings. There has been an increasing demand for valid and reliable instruments for HL and PTHL assessment in this population. This review aims to search and critically discuss instruments used to assess HL and PTHL in people with type 2 diabetes and propose their use in different settings. Methods: Authors conducted a comprehensive, electronic search of original studies using a structured approach of the Scopus and PubMed databases, during November and the first 2 weeks of December 2020 to find relevant papers. The review was conducted in accordance with the Cochrane guidelines and the reporting was based on the PRISMA-ScR. The comparison of instruments was made by utilizing a comparison model related to their structure, measurement scope, range, psychometric properties, validation, strengths, and limitations. Results: The final number of included studies was 24, extracting the following identified instruments: Korean Functional Test HL, NVS, FCCHL, HLS-EU-47, TOFLHA, S-TOFHLA, REALM-R, 3-brief SQ, REALM, HLQ and DNT-15. In all, FCCHL and 3-brief SQ are shown with the broadest measurement scopes. They are quick, easy, and inexpensive for administration. FCCHL can be considered the most useful and comprehensive instrument to screen for inadequate HL. The limitation is that the English version is not validated. Three-brief SQ has many advantages in comparison to other instruments, including that it is less likely to cause anxiety and shame. These instruments can be considered the best for measuring functional HL in patients with diabetes mellitus type 2 and other chronic diseases. PTHL instruments (REALM and DNT-15) did not find the best application in this population. Conclusions: The future research should be directed in validation of the FCCHL in English and establishing of the structural validity of this questionnaire. Developing a specific PTHL questionnaire for this population will be of great help in management of their disease.
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Affiliation(s)
- Marija Levic
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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Whitney RL, White AEC, Rosenberg AS, Kravitz RL, Kim KK. Trust and shared decision-making among individuals with multiple myeloma: A qualitative study. Cancer Med 2021; 10:8040-8057. [PMID: 34608770 PMCID: PMC8607252 DOI: 10.1002/cam4.4322] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/02/2021] [Accepted: 09/18/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is an incurable cancer with complex treatment options. Trusting patient-clinician relationships are essential to promote effective shared decision-making that aligns best clinical practices with patient values and preferences. This study sought to shed light on the development of trust between MM patients and clinicians. METHODS Nineteen individual semi-structured interviews were conducted with MM patients within 2 years of initial diagnosis or relapse for this qualitative study. Interviews were recorded and transcripts were coded thematically. RESULTS We identified three main themes: (1) externally validated trust describes patients' predisposition to trust or distrust clinicians based on factors outside of patient-clinician interactions; (2) internally validated trust describes how patients develop trust based on interactions with specific clinicians. Internally validated trust is driven primarily by clinician communication practices that demonstrate competence, responsiveness, listening, honesty, and empathy; and (3) trust in relation to shared decision-making describes how patients relate the feeling of trust, or lack thereof, to the process of shared decision-making. CONCLUSION Many factors contribute to the development of trust between MM patients and clinicians. While some are outside of clinicians' control, others derive from clinician behaviors and interpersonal communication skills. These findings suggest the possibility that trust can be enhanced through communication training or shared decision-making tools that emphasize relational communication. Given the important role trust plays in shared decision-making, clinicians working with MM patients should prioritize establishing positive, trusting relationships.
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Affiliation(s)
- Robin L Whitney
- The Valley Foundation School of Nursing, San Jose State University, San Jose, California, USA
| | | | - Aaron S Rosenberg
- UC Davis Comprehensive Cancer Center, Sacramento, California, USA.,Department of Internal Medicine, University of California, Davis, Davis, California, USA
| | - Richard L Kravitz
- Department of Internal Medicine, University of California, Davis, Davis, California, USA.,Center for Health Policy and Research, University of California, Davis, Davis, California, USA
| | - Katherine K Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, California, USA
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Rivero-Santana A, Torrente-Jiménez RS, Perestelo-Pérez L, Torres-Castaño A, Ramos-García V, Bilbao A, Escobar A, Serrano-Aguilar P, Feijoo-Cid M. Effectiveness of a decision aid for patients with knee osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage 2021; 29:1265-1274. [PMID: 34174455 DOI: 10.1016/j.joca.2021.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/03/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the effectiveness of a Patient Decision Aid (PtDA) for knee osteoarthritis. METHOD Randomized controlled trial, in which 193 patients were allocated to the PtDA or usual care. Outcome measures were the Decisional Conflict Scale (DCS), knowledge of osteoarthritis and arthroplasty, satisfaction with the decision-making process (SDMP) and treatment preference, assessed immediately after the intervention. At 6 months, the same measures were applied in non-operated patients, whereas those who underwent arthroplasty completed the SDMP and the Decisional Regret Scale (DRS). RESULTS The PtDA produced a significant immediate improvement of decisional conflict (MD = -11.65, 95%CI: -14.93, -8.37), objective knowledge (MD = 10.37, 99%IC: 3.15, 17.70) and satisfaction (MD = 6.77, 99%CI: 1.19, 12.34), and a different distribution of preferences (χ2 = 8.74, p = 0.033). Patients with less than secondary education obtained a stronger effect on decisional conflict (p = 0.015 for the interaction) but weaker for knowledge (p = 0.051). At 6 months, there were no significant differences in any variable, including the rate of total knee replacement. Operated patients showed a low level of regret, which was not affected by the intervention. CONCLUSION The PtDA is effective immediately after its application, but it shows no effects in the medium-term. Future research should investigate which subgroups of patients could benefit more from this intervention, as well as the longitudinal evolution of decision-related psychological variables.
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Affiliation(s)
- A Rivero-Santana
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - R S Torrente-Jiménez
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - L Perestelo-Pérez
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
| | - A Torres-Castaño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - V Ramos-García
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - A Bilbao
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Osakidetza/Basque Health Service, Research Unit, Basurto University Hospital, Bilbao, Bizkaia, Spain.
| | - A Escobar
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Osakidetza/Basque Health Service, Research Unit, Basurto University Hospital, Bilbao, Bizkaia, Spain
| | - P Serrano-Aguilar
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
| | - M Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017SGR 917), Barcelona, Spain.
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Kletečka-Pulker M, Parrag S, Doppler K, Völkl-Kernstock S, Wagner M, Wenzel T. Enhancing patient safety through the quality assured use of a low-tech video interpreting system to overcome language barriers in healthcare settings. Wien Klin Wochenschr 2021; 133:610-619. [PMID: 33528631 PMCID: PMC8195952 DOI: 10.1007/s00508-020-01806-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/30/2020] [Indexed: 11/13/2022]
Abstract
Professional interpretation and translation are key issues in the improvement of public health and patient safety in an area of increased migration and multicultural healthcare system needs. Patient safety requires clear and reliable communication to avoid errors in diagnosis, treatment, and neglect of informed consent. Due to the range of languages to be covered, telephone and video interpretation (VI) can be expected to face up to the demands for trained interpreters available on short notice and in more remote healthcare sites.In a pilot project, we implemented a new up to date model video interpretation unit and used a mixed methods approach integrating quantitative and qualitative data in assessing barriers encountered prior to the use of the pilot system and satisfaction with the use of video interpretation in a number of clinical settings, including inpatient and outpatient units, in Austria. Of all respondents (n = 144) 71% reported frequently encountering language barriers, only 37% reported the use of professional interpreters, 81% reported using siblings, parents or other non-professional interpreters, while a considerable percentage (66%) reported using gestures or drawings to communicate, resulting in very low overall satisfaction rate (only 12%) with the prior situation.In the qualitative study the users observed rapid availability, data protection compliance, ability to see the interpreter despite physical distance, absence of potential external influence resulting from personal relationships, user-friendly nature of the technique, legal certainty, absence of the requirement for personal presence, and cost savings as key benefits in the use of the new technology. Of the users of the system 88% (n = 58) rated it as very good (72%) or good (16%).
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Affiliation(s)
- Maria Kletečka-Pulker
- Institute for Ethics and Law in Medicine, University of Vienna, Spitalgasse 2–4, Hof 2.8, Vienna, Austria
| | - Sabine Parrag
- Institute for Ethics and Law in Medicine, University of Vienna, Spitalgasse 2–4, Hof 2.8, Vienna, Austria
| | - Klara Doppler
- Institute for Ethics and Law in Medicine, University of Vienna, Spitalgasse 2–4, Hof 2.8, Vienna, Austria
| | | | - Michael Wagner
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Thomas Wenzel
- Department of Psychiatry, Medical University of Vienna, Vienna, Austria
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Oliveira IV, do Nascimento MMG, Kakehasi AM, de Morais Neves C, Silva HM, Gonçalves TS, de Moura Aredes R, de Oliveira DR. Association between Health Literacy, Patient Activation, and Functional Capacity in Individuals with Rheumatoid Arthritis. Open Rheumatol J 2021. [DOI: 10.2174/1874312902115010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objectives:
To describe health literacy, patient activation, and functional capacity in individuals with rheumatoid arthritis and to evaluate the associations of health literacy and activation level with functional capacity.
Methods:
A cross-sectional study involving patients with rheumatoid arthritis was carried out at the rheumatology service of a teaching hospital. Health literacy was assessed by applying the short version of the Test of Functional Health Literacy in Adults. Patient Activation was measured by using the summarized version of the Patient Activation Measure. The Health Assessment Questionnaire was applied to evaluate functional capacity. Sociodemographic and clinical variables were also collected to carried out univariate and multivariate analyses by using logistic regression.
Results:
The sample was composed of 179 patients, of whom 90.5% (n = 162) were women. The participants’ average age was 58.3 ± 11.4 years. The prevalence of patients with inadequate or marginal health literacy was high (67%). In contrast, 74% of the patients showed high activation levels. The average score on the Health Assessment Questionnaire was 1.08 ± 0.7. Adequate health literacy was negatively associated with higher Health Assessment Questionnaire scores (OR = 0.42; 95% CI 0.20 – 0.86; p = 0.018), and high activation levels were negatively associated with moderate to severe functional limitation (level 3/moderate activation level – OR = 0.24; 95% CI 0.10 – 0.56; p = 0.001; level 4/high activation level – OR = 0.22; 95% CI 0.08 – 0.50; p = 0.000).
Conclusion:
Health professionals must be aware of health literacy and activation levels of patients with rheumatoid arthritis, given that interventions to improve them represent an opportunity to increase functional capacity.
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Umaefulam V, Fox TL, Barnabe C. Decision Needs and Preferred Strategies for Shared Decision Making in Rheumatoid Arthritis: Perspectives of Canadian Urban Indigenous Women. Arthritis Care Res (Hoboken) 2021; 74:1325-1331. [PMID: 33571403 PMCID: PMC9546336 DOI: 10.1002/acr.24579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Decision making for treatment of rheumatoid arthritis (RA) is complex, with multiple beneficial medication options available, but with the potential for treatment-related adverse effects and significant economic considerations. Indigenous patients make treatment decisions informed by an interplay of clinical, family, and societal factors. Shared decision-making (SDM) may represent an approach to support treatment decisions in a culturally congruent manner. The study identified aspects of arthritis care that Indigenous participants found relevant for SDM and explored preferences for SDM strategies. METHODS A purposive sampling from rheumatology clinics that provide services to Indigenous patients in a Canadian urban centre was used to recruit participants for interviews. Seven participants were recruited to reach content saturation. Interview content was coded by two individuals, including an Indigenous patient with RA, and the data were analyzed via thematic analysis. RESULTS Participants were all women aged 37-61 years living with RA. Participants supported that SDM would be beneficial, primarily to support decisions around treatment plans and medication changes. SDM approaches would need to reflect Indigenous-specific content areas, such as benefits and risks of therapy informed by data from Indigenous patient populations and inclusion of traditional modes of healing. All participants were interested in having a decision coach and preferred that decision aids be in both paper and electronic formats for accessibility. CONCLUSIONS This study advances knowledge in the priority areas and specific content needed in the SDM process, and the preferences of SDM strategies relevant and appropriate for urban Indigenous women living with RA in Canada.
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Affiliation(s)
- Valerie Umaefulam
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Terri-Lynn Fox
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Forcino RC, Thygeson M, O'Malley AJ, Meinders MJ, Westert GP, Elwyn G. Do collaboRATE Scores Reflect Differences in Perceived Shared Decision-Making Across Diverse Patient Populations? Evidence From a Large-Scale Patient Experience Survey in the United States. J Patient Exp 2020; 7:778-787. [PMID: 33294615 PMCID: PMC7705838 DOI: 10.1177/2374373519891039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patient characteristics have been linked to prevalence and quality of shared decision-making (SDM) behaviors across diverse studies of varied size and focus. We aim to evaluate the extent to which patient characteristics are associated with patient-rated SDM scores as measured by collaboRATE and whether or not collaboRATE varies at the provider group level. We used the 2017 California Patient Assessment Survey data set, which included adult patients of 153 California-based medical groups receiving services between January and October 2016. Mixed-effects logistic regression evaluated relationships between collaboRATE scores and patient characteristics. We analyzed 31 265 total survey responses. Among included covariates, patients’ health status, race, primary language, and mode of survey response were significantly associated with collaboRATE scores. Case-mix adjustment is common in healthcare quality measurement and can be useful in pay-for-performance systems. For those use cases, we recommend adjusting collaboRATE scores by patients’ age, health status, gender, race, and language spoken at home, and survey response mode. However, when case-mix adjustment is not required, we suggest highlighting observed disparities across diverse patient populations to improve attention to inequities in patient experience.
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Affiliation(s)
- Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gert P Westert
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Duarte C, Santos E, da Silva JAP, Kristianslund EK, Kvien TK, Dougados M, de Wit M, Gossec L, Heiberg T. The Patient Experienced Symptom State (PESS): a patient-reported global outcome measure that may better reflect disease remission status. Rheumatology (Oxford) 2020; 59:3458-3467. [PMID: 32375173 DOI: 10.1093/rheumatology/keaa149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/28/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In RA, Patient Acceptable Symptom State assesses disease from the patient's perspective, which does not correspond either to disease remission or to full control of disease impact. This study aims to explore the properties of a novel multilevel Patient Experienced Symptom State (PESS). METHODS This was a cross-sectional analysis of two datasets of patients with RA. PESS was assessed through the question: 'Consider how your RA has affected you. If you remain in the coming months as you have been the last week, how would you rate your condition?', with five levels (from 'very bad' to 'very good'). Construct validity of PESS was assessed against validated disease activity [DAS28, Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI)] and impact measures [RA Impact of Disease (RAID) and modified HAQ]. Multiple pairwise comparisons between groups and receiver-operating characteristic curves with Youden Index were performed. RESULTS A total of 1407 patients [74% female, mean (S.d.) age 53.5 (13.4) years, mean disease duration 14.3 (12.0) years and mean DAS28 3.0 (1.5)] were analysed. Overall, 16.3% considered themselves as being in 'very good', 21.6% in 'good' and 31.9% in 'acceptable' state. Disease activity and impact measures differed significantly across the five levels (P < 0.01). Cut-off values corresponding to 'good' and 'very good' PESS states were in the range of low disease activity/remission (for 'good' and 'very good': DAS28-ESR-4v ≤2.6/≤2.3; CDAI ≤5.0/≤3.1; SDAI ≤5.1/≤3.8, respectively) and very low disease impact (RAID domains all ≤1). CONCLUSION PESS 'very good' status corresponds to currently recommended targets for RA management and reflects full control of disease impact. PESS appears to be an easy-to-use and relevant measure in the evaluation of patients with RA.
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Affiliation(s)
- Cátia Duarte
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Coimbra Institute for Clinical and Biomedical Research - Faculty of Medicine, University of Coimbra, Coimbra
| | - Eduardo Santos
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto.,Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - José A P da Silva
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra.,Coimbra Institute for Clinical and Biomedical Research - Faculty of Medicine, University of Coimbra, Coimbra
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxime Dougados
- Université de Paris, Paris.,Department of Rheumatology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | | | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris.,Rheumatology Department, Pitié Salpêtrière Hospital, Sorbone Univeristé-AP-HP, Paris, France
| | - Turid Heiberg
- Faculty of Health and Welfare, Østfold University College, Halden.,Regional Research Support, Oslo University Hospital, Oslo, Norway
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Décary S, Toupin-April K, Légaré F, Barton JL. Five Golden Rings to Measure Patient-Centered Care in Rheumatology. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:686-702. [PMID: 33091246 DOI: 10.1002/acr.24244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Simon Décary
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Quebec, Canada
| | - Karine Toupin-April
- Children's Hospital of Eastern Ontario Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Quebec, Canada
| | - Jennifer L Barton
- Oregon Health & Science University and US Department of Veteran Affairs Portland Health Care System, Portland, Oregon
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39
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Carvajal Bedoya G, Davis LA, Hirsh JM. Patient-Reported Outcomes in Rheumatology Patients With Limited English Proficiency and Limited Health Literacy. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:738-749. [PMID: 33091257 DOI: 10.1002/acr.24243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
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Walker D, Adebajo A, Bukhari M. The benefits and challenges of providing patient education digitally. Rheumatology (Oxford) 2020; 59:3591-3592. [DOI: 10.1093/rheumatology/keaa642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Walker
- Rheumatology, Northumbria Healthcare NHS Foundation Trust, North Shields
| | - Ade Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Academic Rheumatology Group, Sheffield
- Department of Rheumatology, Barnsley Hospital NHS Foundation Trust, Barnsley
| | - Marwan Bukhari
- Rheumatology, University Hospitals of Morecambe Bay NHS Trust, Lancaster, UK
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Effect of trust in primary care physicians on patient satisfaction: a cross-sectional study among patients with hypertension in rural China. BMC FAMILY PRACTICE 2020; 21:196. [PMID: 32957936 PMCID: PMC7507258 DOI: 10.1186/s12875-020-01268-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In rural areas of China, hypertension is on the rise and it is drawing the Chinese government's attention. The health outcomes of hypertension management can be positively impacted by patient satisfaction with primary care physicians (PCPs), and the influence of patient trust on satisfaction cannot be ignored. This study aimed to analyze the effect of trust in PCPs on patient satisfaction among patients with hypertension in rural China, and the influence of patients' socio-demographic characteristics and hypertension-management-related factors. METHODS A multi-stage stratified random sampling method was adopted to investigate 2665 patients with hypertension in rural China. Patient trust and satisfaction were measured using the Chinese version of the Wake Forest Physician Trust Scale and the European Task Force on Patient Evaluation of General Practice. Multiple linear regression was used to analyze the factors influencing patient satisfaction, and structural equation modeling was conducted to clarify the relationships among patient trust and patient satisfaction with PCPs. RESULTS Patients' trust in their PCPs' benevolence had a positive main effect on all three satisfaction dimensions (clinical behavior: β = 0.940, p < 0.01; continuity and cooperation: β = 0.910, p < 0.01; and organization of care: β = 0.879, p < 0.01). Patients' trust in their PCPs' technical competence had a small negative effect on all three satisfaction dimensions (clinical behavior: β = - 0.077, p < 0.01; continuity and cooperation: β = - 0.136, p < 0.01; and organization of care: β = - 0.064, p < 0.01). Patient satisfaction was also associated with region, gender, insurance status, distance from the nearest medical/health-service institution, and number of visits to PCPs in the past year. CONCLUSIONS Patients focused more on physicians' benevolence than on their technical competence. Hence, medical humanities and communication skills education should be emphasized for PCPs. Regarding region-based and health-insurance-based differences, the inequities between eastern, central, and western provinces, as well as between urban and rural areas, must also be addressed.
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42
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Liu LH, Garrett SB, Li J, Ragouzeos D, Berrean B, Dohan D, Katz PP, Barton JL, Yazdany J, Schmajuk G. Patient and clinician perspectives on a patient-facing dashboard that visualizes patient reported outcomes in rheumatoid arthritis. Health Expect 2020; 23:846-859. [PMID: 32270591 PMCID: PMC7495065 DOI: 10.1111/hex.13057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/20/2020] [Accepted: 03/12/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Poor patient-clinician communication around patient-reported outcomes (PROs) is a barrier to the effective management of rheumatoid arthritis (RA). We aimed to develop an RA 'dashboard' that could facilitate conversations about PROs and that would be acceptable to a wide range of patients, including English and Spanish speakers and patients with adequate or limited health literacy. METHODS A diverse group of RA patients along with clinicians from two academic rheumatology clinics joined separate focus groups. We solicited feedback and made iterative changes to mock-ups of an RA dashboard that visualized PROs using a human-centred design process. We used the thematic analysis method to identify and characterize themes from the focus groups and used these insights to refine the dashboard. RESULTS We conducted six focus groups involving 25 RA patients and three groups with 11 clinicians. Patients and clinicians agreed that the dashboard could enhance communication about PROs and RA disease activity and could promote patient self-management. Patients varied in their (a) comprehension, (b) preferences for the display and features of the dashboard, and (c) desired uses for the dashboard. Clinicians expressed significant concerns about the logistics of using the dashboard in clinical practice. CONCLUSION Using principles of human-centred design, we created an RA dashboard that was well-accepted among patients and clinicians. The ability to customize the data display is important for tailoring the dashboard to patients with diverse needs and preferences. Special attention should be given to feasibility concerns voiced by clinicians.
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Affiliation(s)
- Lucy H. Liu
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
- San Francisco VA Medical CenterSan FranciscoCalifornia
| | - Sarah B. Garrett
- Philip Lee Institute for Health Policy StudiesUCSFSan FranciscoCalifornia
| | - Jing Li
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
| | - Dana Ragouzeos
- School of Medicine Technology Unit (SOMTech)University of California ‐ San FranciscoSan FranciscoCalifornia
| | - Beth Berrean
- School of Medicine Technology Unit (SOMTech)University of California ‐ San FranciscoSan FranciscoCalifornia
| | - Daniel Dohan
- Philip Lee Institute for Health Policy StudiesUCSFSan FranciscoCalifornia
| | - Patricia P. Katz
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
- Philip Lee Institute for Health Policy StudiesUCSFSan FranciscoCalifornia
| | - Jennifer L. Barton
- VA Portland Health Care SystemOregon Health Sciences UniversityPortlandOregon
| | - Jinoos Yazdany
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
| | - Gabriela Schmajuk
- Division of RheumatologyUniversity of California ‐ San FranciscoSan FranciscoCalifornia
- San Francisco VA Medical CenterSan FranciscoCalifornia
- Philip Lee Institute for Health Policy StudiesUCSFSan FranciscoCalifornia
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43
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Cho SK, Sung YK. Treatment strategy for patients with rheumatoid arthritis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.7.422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the joints, causing joint destruction, functional disability, and reduced quality of life in patients. The aim of RA treatment is to decrease the inflammation, prevent joint damage, and improve patientsʼ quality of life while minimizing progression of the disease. Both early detection and intervention with disease-modifying anti-rheumatic drugs (DMARDs) have been reported to improve therapeutic outcomes. Treatment with DMARDs should be started immediately after the diagnosis is established, with methotrexate as the best initial drug of choice. Disease activity should be regularly monitored. Targeted therapies can be considered in patients with persistent active disease despite methotrexate therapy. Remission or low disease activity is the preferred treatment target. There are two major classes of DMARDs: conventional synthetic DMARDs and the targeted therapies specific to pro-inflammatory cytokines including biologic DMARDs and small molecule inhibitors. Recently, the importance of shared decision making, in which patients and clinicians make decisions together, and education of the patient has been emphasized in the treatment strategies of RA. This review summarizes the effectiveness and safety of the DMARDs currently available for RA treatment. Recommendations for RA management would also be discussed in this article.
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Georgopoulou S, Nel L, Sangle SR, D'Cruz DP. Physician-patient interaction and medication adherence in lupus nephritis. Lupus 2020; 29:1168-1178. [PMID: 32623951 DOI: 10.1177/0961203320935977] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The quality of physician-patient interaction can have a significant impact on medication adherence. Little is known about this relationship in patients with lupus nephritis. METHODS A cross-sectional, quantitative study. Data collected included demographics, current medication, systemic lupus erythematosus disease activity index, medication adherence, beliefs about medicines, shared decision-making, patient-doctor depth of relationship, patient-doctor quality of relationship, interpersonal trust in a physician and illness perceptions. RESULTS Ninety-eight patients with lupus nephritis completed the questionnaires. Logistic regression indicated that medication adherence was significantly predicted by (a) interpersonal trust in a physician (B = 0.85, Wald 3.94, 95% confidence interval (CI) 1.01, 5.44; P = 0.05); (b) timeline cyclical (B = -0.89, Wald 4.95, 95% CI 0.19, 0.90; P < 0.05) and beliefs about the necessity of medicines (B = 0.75, Wald 4.14, 95% CI 1.03, 4.38; P < 0.05). Mediation analysis showed that beliefs about the necessity of medicines significantly mediated the relationship between trust and medication adherence when adjusted for age (B = 0.48, 95% CI 0.06, 1.08; P < 0.01). A further mediation analysis showed that patient-doctor depth of relationship (B = 0.05, 95% CI 0.01, 0.09; P < 0.001), shared decision-making (B = 0.07, 95% CI 0.01, 0.13; P < 0.001) and patient-doctor quality of relationship (B = 0.08, 95% CI 0.01, 0.16; P < 0.001) significantly mediated the relationship between illness coherence and interpersonal trust in a physician. CONCLUSION The findings highlighted two key elements: (a) the importance of trust in relation to medication adherence; and (b) a good understanding of patients' illness is linked to a better relationship with their doctor and greater participation in shared decision-making which is associated with increased trust. Tailored psycho-educational interventions could contribute to improving the patient-doctor relationship quality, trust and increased shared decision-making, which, in turn, might improve medication adherence in patients with lupus nephritis.
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Affiliation(s)
- Sofia Georgopoulou
- Department of Inflammation Biology, King's College London, London, UK.,The Royal Marsden Hospital, Applied Health Research Group, London, UK
| | - Louise Nel
- Guy's Hospital, Louise Coote Lupus Unit, London, UK
| | | | - David P D'Cruz
- Department of Inflammation Biology, King's College London, London, UK.,Guy's Hospital, Louise Coote Lupus Unit, London, UK
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Hirsh J, Wood P, Keniston A, Boyle D, Quinzanos I, Caplan L, Davis L. Universal Health Literacy Precautions Are Associated With a Significant Increase in Medication Adherence in Vulnerable Rheumatology Patients. ACR Open Rheumatol 2020; 2:110-118. [PMID: 31957348 PMCID: PMC7011426 DOI: 10.1002/acr2.11108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Our objective was to determine the impact of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, on medication adherence, patient satisfaction, and feasibility in all patients; its effect on the clinical disease activity index (CDAI) was studied in a rheumatoid arthritis (RA) subpopulation. METHODS Data collected during a 6-month prospective quality assurance intervention was compared with data from a prior 6-month period. Interventions included 1) encouraging questions, 2) teach-back communication, and 3) brown-bag medication review. Analysis was performed using linear regression or generalized estimating equation (GEE) regression. RESULTS During the intervention period, 46 physicians completed 1737 patient visits. Questions were encouraged, and teach-back communication was performed in more than 90% of visits. Brown-bag medication reviews were performed in 47% of visits overall and 69% of visits in a subgroup that received additional reminder calls. Visit duration and patient satisfaction were not significantly increased. Adherence for rheumatology-related medications that were prescribed both before and during the intervention increased by 22% (P ≤ 0.001; by GEE). Teach-back communication predicted a statistically significant improvement in medication adherence in this subpopulation (by linear regression). The mean CDAI did not improve; however, African American race and Hispanic ethnicity were associated with a decreased CDAI (by GEE). CONCLUSION Implementation of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, improved medication adherence in our safety-net clinic, with particularly strong effects seen with teach-back communication. In certain populations, use of the toolkit may also improve RA disease activity. This is the first study to document improved medication adherence with this intervention in a real-world setting.
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Affiliation(s)
- Joel Hirsh
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Patrick Wood
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Angela Keniston
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Dennis Boyle
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Itziar Quinzanos
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Liron Caplan
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Lisa Davis
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
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Warren-Findlow J, Coffman MJ, Thomas EV, Krinner LM. ECHO: A Pilot Health Literacy Intervention to Improve Hypertension Self-Care. Health Lit Res Pract 2019; 3:e259-e267. [PMID: 31893258 PMCID: PMC6901363 DOI: 10.3928/24748307-20191028-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/20/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Medication adherence and diet and weight control are essential contributors to blood pressure management. Low health literacy is also associated with poor health behaviors and outcomes among adults with hypertension. Objective: This study aims to pilot test the acceptability and feasibility of a brief health literacy intervention focused on hypertension self-care and to assess changes in self-care activities. Methods: We recruited patients with hypertension who were treated at a low-cost clinic. A 2-hour evidence-based class was delivered in Spanish and English, and a telephone follow-up survey was conducted 1 month later. Intervention content included health literacy activities, nutrition education, and medication use. Participants engaged in reading, writing, a group activity, and critical discussion. Health literacy was measured using the Newest Vital Sign and the Test of Functional Health Literacy in Adults. Key Results: The intervention was delivered to 52 English- (52%) and Spanish-speaking adults (48%) with a mean age of 52.3 years (SD 7.9). More than one-half had Stage 1 or 2 hypertension (54%), and 56% had inadequate health literacy. At 1-month follow-up, participants showed improvement on all self-care measures with significant mean differences (p < .05) on diet adherence and weight management activities. These improvements were largely among Hispanics and those with low health literacy. Conclusions: Results suggest that teaching targeted self-care skills in a brief health literacy intervention can be effective in improving self-care activities relating to diet and weight management among vulnerable populations. [HLRP: Health Literacy Research and Practice. 2019;3(4):e259–e267.] Plain Language Summary: This study explored the effects of a 2-hour health education class on self-care behaviors. At the follow-up, participants reported better self-care behaviors. Effects were more pronounced among those with low health literacy, suggesting brief exposure to health education may improve high blood pressure in this population.
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Affiliation(s)
- Jan Warren-Findlow
- Address correspondence to Jan Warren-Findlow, PhD, Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223-0001;
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Ousseine YM, Durand MA, Bouhnik AD, Smith AʻB, Mancini J. Multiple health literacy dimensions are associated with physicians' efforts to achieve shared decision-making. PATIENT EDUCATION AND COUNSELING 2019; 102:1949-1956. [PMID: 31130338 DOI: 10.1016/j.pec.2019.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/23/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Shared decision-making (SDM) in health care is widely encouraged. However, for SDM to occur patients need to be able to obtain, understand and apply medical information. Our aim was to assess the relationship between health literacy (HL), numeracy and SDM (using French translations of validated measures). METHODS A cross-sectional survey using a self-administered online questionnaire was proposed to all members of the Seintinelles association. Several scales were used to measure HL (FCCHL and 3HLQ/SILS), numeracy (SNS-3), the SDM process (CollaboRATE) and explore their inter-relationships. RESULTS Data from 2 299 respondents (96.7% women, 46.1% with a history of cancer) were analysed. All measurement scales showed adequate psychometric properties. Functional HL, communicative HL and numeracy were positively associated with SDM while no significant relation was observed between critical HL and SDM. Furthermore, perceived difficulties in asking physicians' questions and deprivation were negatively associated with SDM. CONCLUSION Patient support to reach SDM requires high levels of HL, particularly in the functional and communicative domains. Efforts must be made to improve access and understanding of health information. PRACTICE IMPLICATIONS Brief self-reported measures could be used to screen for low levels of health literacy, tailor information accordingly and improve patient involvement in healthcare decision-making.
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Affiliation(s)
- Youssoufa M Ousseine
- "Cancer, Biomedicine & Society" group, SESSTIM, INSERM, IRD, Aix-Marseille Univ, Marseille, France
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Anne-Déborah Bouhnik
- "Cancer, Biomedicine & Society" group, SESSTIM, INSERM, IRD, Aix-Marseille Univ, Marseille, France
| | - Allan ʻBen' Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Australia
| | - Julien Mancini
- "Cancer, Biomedicine & Society" group, SESSTIM, BIOSTIC, APHM, INSERM, IRD, Aix-Marseille Univ, Marseille, France.
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Mathijssen EGE, Vriezekolk JE, Popa CD, van den Bemt BJF. Shared decision making in routine clinical care of patients with rheumatoid arthritis: an assessment of audio-recorded consultations. Ann Rheum Dis 2019; 79:170-175. [DOI: 10.1136/annrheumdis-2019-216137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 01/22/2023]
Abstract
ObjectivesAlthough shared decision making (SDM) is advocated in rheumatoid arthritis (RA) treatment, it is largely unclear when, how and to what extent SDM is applied in routine clinical care of patients with RA. This study aimed to investigate the level of SDM in RA treatment from an observer perspective and to assess associations between the level of SDM and characteristics of the clinician, patient and consultation.MethodsThe level of SDM was investigated by scoring audio-recordings of 168 routine consultations with unique patients with the observer patient involvement (OPTION) scale (scale 0–100, higher OPTION scores indicating higher levels of SDM). Associations between the level of SDM and characteristics of the clinician, patient and consultation were assessed using multilevel modelling. Statistical significance was set at p<0.05.ResultsThe mean OPTION score was 28.3 (SD=15.1). The multilevel model included four characteristics: clinician age, patient age, consultation duration and type of treatment decision. There were significant, positive associations between the level of SDM and the consultation duration (b=0.63, 95% CI 0.16 to 1.11), decision for stopping and/or starting medication (b=14.30, 95% CI 5.62 to 22.98), decision for adjusting medication doses (b=8.36, 95% CI 3.92 to 12.81) and decision for administering single dose glucocorticoids (b=15.03, 95% CI 9.12 to 20.93). Thus, a higher level of SDM was significantly associated with a longer consultation duration and the type of treatment decision. No other significant associations were found.ConclusionsOverall, the level of SDM in RA treatment leaves room for improvement. To foster SDM in routine clinical care, training programmes on patient-centred communication skills may be helpful.
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Weir K, Nickel B, Naganathan V, Bonner C, McCaffery K, Carter SM, McLachlan A, Jansen J. Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions About Their Medicines. J Gerontol B Psychol Sci Soc Sci 2019; 73:e98-e107. [PMID: 29190369 DOI: 10.1093/geronb/gbx138] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/16/2017] [Indexed: 01/27/2023] Open
Abstract
Objectives Polypharmacy in the older population is increasing-and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing) but a collaborative approach between patient and doctor is required. This study explores decision-making about polypharmacy with older adults and their companions. Method Semi-structured interviews were conducted with 30 older people (aged 75+ years, taking multiple medicines) and 15 companions. Framework analysis was used to identify qualitative themes. Results Participants varied considerably in attitudes towards medicines, preferences for involvement in decision-making, and openness to deprescribing. Three types were identified. Type 1 held positive attitudes towards medicines, and preferred to leave decisions to their doctor. Type 2 voiced ambivalent attitudes towards medicines, preferred a proactive role, and were open to deprescribing. Type 3 were frail, perceived they lacked knowledge about medicines, and deferred most decisions to their doctor or companion. Discussion This study provides a novel typology to describe differences between older people who are happy to take multiple medicines, and those who are open to deprescribing. To enable shared decision-making, prescribers need to adapt their communication about polypharmacy based on their patients' attitudes to medicines and preferences for involvement in decisions.
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Affiliation(s)
- Kristie Weir
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, New South Wales, Australia
| | - Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, Australia
| | - Carissa Bonner
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, Australia
| | - Stacy M Carter
- Sydney Health Ethics, The University of Sydney, New South Wales, Australia
| | - Andrew McLachlan
- Centre for Education and Research on Ageing (CERA), Ageing and Alzheimer's Institute, Concord Hospital, The University of Sydney, New South Wales, Australia.,Faculty of Pharmacy, The University of Sydney, New South Wales, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, New South Wales, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, Australia
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Barton JL, Hulen E, Schue A, Yelin EH, Ono SS, Tuepker A, Koenig CJ. Experience and Context Shape Patient and Clinician Goals For Treatment of Rheumatoid Arthritis: A Qualitative Study. Arthritis Care Res (Hoboken) 2019; 70:1614-1620. [PMID: 29438606 DOI: 10.1002/acr.23541] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/06/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Alignment of patient and clinician goals, which is central to effective patient-centered care, has been linked to improved patient experience and outcomes but has not been explored in rheumatoid arthritis (RA). The aim of this study was to analyze goal conceptualization among RA patients and clinicians. METHODS Seven focus groups and 1 semi-structured interview were conducted with RA patients and clinicians who were recruited from 4 rheumatology clinics. An interview guide was developed to explore goal concordance related to RA treatment. Researchers utilized a concurrent deductive-inductive data analysis approach. RESULTS Nineteen patients (mean age 55 years, 74% female, 32% non-white, and 26% Spanish-speaking) and 18 clinicians (44% trainees, 44% female, 28% non-white) participated. Across clinician and patient focus groups, the 2 identified domains were patient knowledge of RA and psychosocial dynamics (stress) in RA treatment. Within the knowledge domain, 3 themes emerged: RA knowledge for informed choice, RA knowledge to ensure adherence and medication safety, and clinician assumption of patient inability to interpret information. Within the second domain of RA and stress, 2 themes emerged: patient illness experience informs treatment context in ways that are not shared by clinicians, and the impact of patient-clinician communication and decision-making on goal concordance. CONCLUSION Knowledge is a shared goal, but RA patients and clinicians hold divergent attitudes towards this goal. While knowledge is integral to self-management and effective shared decision-making, mismatches in attitudes may lead to suboptimal communication. Tools to support patient goal-directed RA care may promote high quality patient-centered care and result in reduced disparities.
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Affiliation(s)
- Jennifer L Barton
- Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | | | | | | | - Sarah S Ono
- Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | - Anais Tuepker
- Oregon Health & Science University and VA Portland Health Care System, Portland, Oregon
| | - Christopher J Koenig
- San Francisco State University, San Francisco, California, VA Palo Alto Health Care System, Palo Alto, California, and VA San Francisco Health Care System, San Francisco, California
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