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

Abstract

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.

Preference Phenotypes in Support of Shared Decision–Making at Point‐of‐Care for Patients With Rheumatoid Arthritis: A Proof‐of‐Concept Study

“…Our results are largely consistent with 3 other decision aids developed for RA patients who were eligible for a change in therapy. Two were designed for use prior to the encounter and 1 for use during the visit . Fraenkel et al developed and evaluated the use of an interactive web‐based decision aid designed for RA patients who were candidates for biologic therapy in a randomized controlled trial.…”

Shared Decision Making in the Emergency Department Among Patients With Limited Health Literacy: Beyond Slower and Louder

“…Though work has begun to focus on SDM among patients with LHL or low numeracy, 22 to our knowledge this has not been studied among patients in the ED setting. To this end, the goal of this manuscript was to identify recommended best practices, gaps in evidence, and research needs related to SDM in the ED among patients with LHL or low numeracy.…”

Shared Decision Making With Vulnerable Populations in the Emergency Department

“…Additionally, it is not optimal to simply translate SDM clinical decision tools into other languages. 35 Ideally, SDM materials and decision aids should be specifically developed for each LEP population.…”