She underscored the importance of systematically assessing these invisible barriers in practice to lead toward more pragmatic, community-informed solutions. “Using decision aids and communication tools in consultations can help clinicians have open, non-judgmental conversations about how patients find, understand and act on health information,” she said, adding that this can help make visible the challenges of treating certain patients.
Action Plans
Dr. Toupin-April emphasized that shared decision making can be used to make a variety of decisions in rheumatology that not only include choosing the type of medication for a given disease, but also for managing daily symptoms such as pain, fatigue, stiffness and mental health issues.
She walked session members through a variety of interventions that can facilitate shared decision making in clinical practice, including patient decision aids, decision coaching and healthcare provider training. She provided a number of examples of patient decision aids, including an example of a generic patient decision aid that can be used for different disease types, a decision aid for patients with RA with low literacy, and a web-based patient decision aid for juvenile idiopathic arthritis, called the JIA Option Map, which is currently being tested as an app and not yet available to the public.
She ended by emphasizing healthcare providers can identify improving shared decision making in their practice by evaluating how they follow the shared decision making process, and whether decision-making outcomes in their practice are optimal. “They can identify how to address these needs by choosing [shared decision making] interventions,” she said.
Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.
References
- Morrison T, Foster E, Dougherty J, et al. Shared decision making in rheumatology: a scoping review. Semin Arthritis Rheum. October 2022:152041.
- Barton JL, Trupin L, Tonner C, et al. English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthrtis. J Rheumatol. 2014;31:1290–1297.
- Barton JL, Trupin L, Schillinger E, et al. Use of low-literacy decision aid to enhance knowledge and reduce decisional conflict among a diverse population of adults with rheumatoid arthritis: results of a pilot study. Arthritis Care & Research. 2016;68(7):889–898.
- Barton JL, Niederhausen M, Tuepker A, et al. Implementation of shared decision making in rheumatoid arthritis: a study protocol for RAiSeD (Rheumatoid Arthritis Shared Decision Making) stepped wedge, cluster-randomized trial. Trials. 2025;29(1):381.
- Breathett K, Jones J, Lum HD, et al. Factors related to physician clinical decision-making for African-Americans and Hispanic patients: a qualitative meta-synthesis. J Racial Ethn Health Disparities. Dec 2018;5(6):1215–1229.
- Adas MA, Norton S, Balachandran S, et al. Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study. Rheumatology (Oxford). Dec 2022;62(1):169–180.
- Fraenkel L, Rabidou N, Dhar R. Are rheumatologists’ treatment decisions influenced by patients’ age? Rheumatology (Oxford). Dec 2006;45(12):1555–1557.
- Dey M, Budhathoki S, Elwell H, et al. Association of health literacy with disease outcomes in inflammatory arthritis: a systematic review. Ann Rheum Dis. Sept 2025:S0003-4967(25)04317.1.
