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

Barton, Jennifer L.; Trupin, Laura; Tonner, Chris; Imboden, John B.; Katz, Patricia P.; Schillinger, Dean; Yelin, Edward H.

doi:10.3899/jrheum.131350

Cited by 97 publications

(99 citation statements)

References 54 publications

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“…Following the practice in the literature, TIP scores were grouped above and below the median (7). The 2-item validated decision-making subscale of the IPC is calculated as the mean score for 2 items, “How often did you and your doctors work out a treatment plan together?” and, “If there were treatment choices, how often did doctors ask if you would like to help decide your treatment?” The 5-item response ranged from 1 (“never”) to 5 (“always”).…”

Section: Methodsmentioning

confidence: 99%

“…We have found that nearly one-third of adults with RA report suboptimal shared decision-making (SDM) communication with their clinicians (7), and patients with lower education, limited health literacy, lower trust in physician, and limited English language proficiency are more likely to report suboptimal SDM. Thus, lack of clear communication in these conversations may contribute to health disparities (8, 9).…”

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confidence: 99%

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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

Barton

Trupin

Schillinger

et al. 2016

Arthritis Care & Research

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Objective Despite innovations in treatment of rheumatoid arthritis (RA), adherence is poor and disparities persist. Shared decision making (SDM) promotes patient engagement and enhances adherence, however few tools support SDM in RA. Our objective was to pilot a low literacy medication guide and decision aid to facilitate patient-clinician conversations about RA medications. Methods RA patients were consecutively enrolled into one of three arms: (1) control, patients received existing medication guide prior to clinic visit; (2) adapted guide prior to visit; (3) adapted guide prior plus decision aid during visit. Outcomes were collected immediately post-visit, at 1-week, 3- and 6-month interviews. Eligible adults had to have failed at least one DMARD and fulfill one of the following: age >65, immigrant, non-English speaker, < high school education, limited health literacy, racial/ethnic minority. Primary outcomes were knowledge of RA medications, decisional conflict, and acceptability of interventions. Results Majority of 166 patients were immigrants (66%), non-English speakers (54%), and had limited health literacy (71%). Adequate RA knowledge post visit in arm 3 was higher (78%) than arm 1 (53%, adjusted OR 2.7, 95% CI 1.2–6.1). Among patients with a medication change, there was lower (better) mean decisional conflict in arms 2 and 3 (p=0.03). No significant differences in acceptability. Conclusion A low literacy medication guide and decision aid was acceptable, improved knowledge, and reduced decisional conflict among vulnerable RA patients. Enhancing knowledge and patient engagement with decision support tools may lead to medication choices better aligned with patient values and preferences in RA.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Barton

Trupin

Schillinger

et al. 2016

Arthritis Care & Research

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View full text Add to dashboard Cite

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“…85,86 In a cohort of individuals with rheumatoid arthritis, for example, limited health literacy was significantly associated with patient report of sub-optimal shared decision making. 87 In IBD, the selection of antiTNF therapy is an example of a highly preference-sensitive decision. 88 We have learned that IBD patients' perceptions of risk are extremely variable as they relate to antiTNF medications, 65 and patients' willingness to accept risk tends to increase with illness severity.…”

Section: Shared Decision Making Patient Education and Empowermentmentioning

confidence: 99%

Understanding Health Literacy and its Impact on Delivering Care to Patients with Inflammatory Bowel Disease

Tormey

Farraye

Paasche‐Orlow

2016

Inflammatory Bowel Diseases

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Health literacy (HL) is the extent to which individuals have the capacity to obtain, process, and understand basic health information that is needed to make appropriate health decisions. As adults with inflammatory bowel disease engage in complex health decisions throughout their lives, attention is needed regarding the influence of HL on the lives of people with inflammatory bowel disease. About one-third of adults in the United States have limited HL. Limited HL is a potentially modifiable risk factor that has been associated with barriers to patient-provider communication and worse health outcomes for people with a range of chronic diseases. Gastroenterologists must recognize the role of HL in their practice. Limited HL can affect a patient's ability to understand the purpose of a screening test for colorectal cancer, understand the concept of an asymptomatic yet chronic disease, ask questions in an office visit and engage in shared decision making. Gastroenterologists must approach each patient as potentially having limited HL and use clear communication strategies in all encounters. Currently, there is a lack of training, education, and support for health care providers to meet the needs of patients with limited HL. More research is needed in inflammatory bowel disease to understand the impact of limited health literacy on health outcomes in this population and develop effective systems-based interventions to reduce the health literacy burden on patients. (Inflamm Bowel Dis 2016;22:745-751)

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“…Limited local language proficiency and health literacy are additionally implicated in patient-rated suboptimal shared decision-making communication with their clinicians 43 . Further, ethnicity is associated with differences in prescribing disease-modifying antirheumatic drugs 44 , and discord between patient and physician assessment of "disease control" for patients of low SES and ethnic minority groups 45 .…”

Section: Rheumatologymentioning

confidence: 99%

Communication Vulnerabilities in Working-age Australians with Musculoskeletal Conditions: A Cross-sectional Analysis

Lowe

Taylor²,

Hill³

2015

J Rheumatol

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Objective.To estimate the prevalence of communication vulnerability (CV) and its association with various health measures among working-age Australians with musculoskeletal conditions (MSK). The various vulnerability characteristics may lead to inadequate communication between consumers and healthcare professionals.Methods.Prevalence of CV among 18–64 year olds, with or without MSK, was analyzed using the Australian Bureau of Statistics’ National Health Survey 2007–08 data. Associations between CV and measures of health complexity (accumulating multimorbidity and risk factors) and health burden (poorer self-rated health, psychological distress, and pain restricting work) in the MSK population were estimated using logistic regression. Further analyses were conducted for each vulnerability characteristic to determine the degree of association (crude and adjusted) with measures of interest.Results.CV were more prevalent in working-age Australians with MSK (65%) than those without (51%). Adjusted for age and sex among working-age Australians with at least 1 MSK, those with 1 or more CV were more likely to have multimorbidity [adjusted OR (aOR) = 1.8, 95% CI 1.5–2.2], lifestyle risk factors (aOR = 2.1, 95% CI 1.5–2.8), poorer self-rated health (aOR = 3.4, 95% CI 2.7–4.2), greater psychological distress (aOR = 2.9, 95% CI 2.3–3.7), and pain restricting employment (aOR = 1.7, 95% CI 1.4–2.1) compared with those without CV.Conclusion.For working-age people, there is an association between MSK and CV. For those with MSK, CV were associated with increased likelihood of health complexity and burden. These findings have policy and clinical relevance. Research is needed to determine whether interventions that address these specific CV characteristics reduce the burden of disease within these populations.

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

Cited by 97 publications

References 54 publications

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

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

Understanding Health Literacy and its Impact on Delivering Care to Patients with Inflammatory Bowel Disease

Communication Vulnerabilities in Working-age Australians with Musculoskeletal Conditions: A Cross-sectional Analysis

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