An experimental evaluation of patient decision aid design to communicate the effects of medications on the rate of progression of structural joint damage in rheumatoid arthritis

Martin, Richard W.; Brower, Matthew E.; Geralds, Alexander; Gallagher, Patience; Tellinghuisen, Donald J.

doi:10.1016/j.pec.2011.06.001

Cited by 32 publications

(27 citation statements)

References 25 publications

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“…The effects on adherence, cost-effectiveness, and use with lower literacy populations were deemed to require further evaluation. To date, several investigators have published studies on the development and testing of decision support tools designed for patients with RA (53–55), but only one addressed the needs of patients with low literacy (54) and none addressed the barriers of limited English proficiency. Given the findings of this study and what is known about disparities in RA, we could begin by enhancing the provision of literacy-appropriate educational resources that describe the condition, therapies, risks/benefits and potential harms to all patients with RA; training clinicians who care for RA patients in communication skills and techniques of delivering patient-centered care (56); increasing awareness of shared decision-making and the use of decision support tools; and promoting the development and implementation of low literacy decision aids to facilitate shared decision-making around complex therapies.…”

Section: Discussionmentioning

confidence: 99%

English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis

Barton

Trupin²,

Tonner³

et al. 2014

J Rheumatol

101

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Objective Treat to Target guidelines promote shared decision-making (SDM) in rheumatoid arthritis (RA). Also, due to high cost and potential toxicity of therapies, SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision-making in two cohorts of adults with RA. Methods Data were derived from patients enrolled in one of two longitudinal, observational cohorts (UCSF RA Cohort and RA Panel). Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision-making. Measures of trust in physician, education, and language proficiency were also asked. Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately. Results Of 509 patients across two cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel. Conclusions This study of over 500 adults with RA from two demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the Panel. These findings underscore the need to examine the impact of SDM on health outcomes in RA.

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Section: Discussionmentioning

confidence: 99%

English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis

Barton

Trupin²,

Tonner³

et al. 2014

J Rheumatol

101

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“…Furthermore, text and numeric presentations can interact to affect comprehension [48]. Moreover, if graphics, including both quantitative and illustrative, do not directly reinforce the textual information, they can distract from core information and reduce recall accuracy [49]. Finally, although evidence presented above suggests that more detailed DAs can generally result in small improvements in the amount of relevant information recalled by patients, there are times when less information results in greater comprehension [50].…”

Section: Discussionmentioning

confidence: 99%

Providing information about options in patient decision aids

Feldman‐Stewart

O’Brien

Clayman

et al. 2013

BMC Med Inform Decis Mak

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BackgroundLegal, ethical, and psychological arguments indicate that patients need to receive information about their health situations before their care decisions are made. Patient decision aids (PtDAs) are designed to help patients make decisions; therefore, they should provide information that results in patients understanding their health situation. We reviewed studies that assessed the impact of PtDAs on patient knowledge and on their feeling of being uninformed.MethodsOur data sources were a published Cochrane Collaboration review that included randomized controlled trials (RCTs) published before 2010 and a systematic review we conducted of RCTs published in 2010. We included trials that compared 1) PtDAs to usual care, and 2) PtDAs with simple information to PtDAs with more detailed information. Outcomes included patients' knowledge and their feeling of being uninformed. Data were analyzed quantitatively and qualitatively. Meta-analyses of similar studies estimated the size of differences.ResultsThirty-nine RCTs compared a PtDA to usual care and all showed higher knowledge scores for patients in the PtDA groups; a meta-analysis estimated the advantage at 14 (of 100) points. Sixteen (of 39) studies used the Feeling Uninformed subscale; a meta-analysis estimated a reduction of 7 (of 100) points in the PtDA group over usual care. Twenty-one studies compared simple- to more-detailed information in PtDAs. There was a small overall advantage for more detailed information on knowledge scores; a meta-analysis estimated the advantage at 5 (of 100) points. Only one study found higher mean knowledge scores for simpler information. Nine (of 21) studies reported using the Feeling Uninformed subscale and a meta-analysis suggested a reduction of 3 (of 100) points for the more-detailed PtDAs over those with simpler information. Only one study found that simpler information resulted in patients feeling more informed.ConclusionsIt appears that PtDAs result in patients having higher knowledge scores and in reduced feelings of being uninformed over patients who receive usual care. It also appears that PtDAs with more detailed information generally result in slightly higher knowledge and lower “Feeling Uninformed” scores than those with simpler information, but the differences are small and can be reversed under some circumstances.

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“…One of the hallmarks of biomedical professionals' communication about genetic testing is the theory of nondeterminism, retaining a neutral stance that allows a patient to see all the possible options for decision making (Baty, 2009;Martin, Brower, Geralds, Gallagher, & Tellinghuisen, 2012). However, the insertion of qualifying or contingent language into statements in PDAs can also become a form of linguistic hedging, another form of ambivalence.…”

Section: Ambivalencementioning

confidence: 99%

Patient Decision Aids for Prenatal Genetic Testing: Probability, Embodiment, and Problematic Integration

Kirkscey

2016

Health Communication

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Patient decision aids (PDAs) are documents that attempt to support patient participation in biomedical decision making by discussing information and options. Scholars have called for further elaboration and application of communication theory relating to the construction and uses of PDAs. This article analyzes gateway documents, a genre of PDAs that includes texts from noncommercial websites returned during an initial inquiry for decision-making information. Problematic integration theory informs and extends a meaning of balance in a sample of four PDAs for prenatal genetic testing. The study addresses several communication opportunities, including discussions of benefits, disadvantages, providers' scientific knowledge, and patients' embodied knowledge. The PDA authors' emphases on statistical risk without more inclusive considerations of embodied knowledge highlight a conclusion that the documents in the sample are imbalanced. This research serves to introduce a theoretical communication context for analysis of PDAs that may assist scholars in further contributions to the interdisciplinary field of biomedical communication.

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An experimental evaluation of patient decision aid design to communicate the effects of medications on the rate of progression of structural joint damage in rheumatoid arthritis

Cited by 32 publications

References 25 publications

English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis

English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis

Providing information about options in patient decision aids

Patient Decision Aids for Prenatal Genetic Testing: Probability, Embodiment, and Problematic Integration

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