Shared decision making requires patients and clinicians to share information about safety, efficacy and treatment burden. But over the past two decades, the expansion of medications for patients with rheumatoid arthritis (RA) has increased the complexity of doctor-patient communication and determining treatment. Additional communication issues, such as language barriers, limited time and lack of health literacy, limit shared decision making and may even affect patient outcome.
“We have found that nearly one-third of adults with RA report suboptimal shared decision-making communication with their clinicians,” write Jennifer L. Barton, MD, of the Oregon Health & Science University in Portland, and her colleagues in their latest research paper. Additionally, “RA patients who are nonwhite, immigrants or who have limited English-language proficiency have higher disease activity and poorer function despite access to effective therapies.”
Dr. Barton and colleagues designed a low-literacy medication guide and decision aid, called RA Choice. Developed in three languages, the program facilitates treatment-related conversations between patients and clinicians to increase patient knowledge and potentially support shared decision making. The program’s efficacy and clinical feasibility were assessed during a practice-based pilot study, the results of which were published in the July 2016 issue of Arthritis Care & Research.
Participants had to have RA, have failed treatment with at least one disease-modifying anti-rheumatic drug and fulfill one of the following criteria: age >65, immigrant, non-English speaker, less than high school education, limited health literacy and racial/ethnic minority. One-hundred and sixty-six patients were sorted into three groups: 1) the control group with patients receiving existing medication guidelines at visits, 2) a group using only the adapted medication guide prior to visits, and 3) a group using both the adapted medication guide before visits plus the decision aid during visits.