Background/Purpose: This cross-sectional study aimed to analyze the willingness for shared decision making (SDM) of rheumatologic patients.

Methods: All rheumatic disease patients assisted at a specialty care unit were invited to participate in this study. A three parts questionnaire was applied (demographic, clinical data and 3 scenarios that simulate a clinical encounter). The scenarios presented the 3 typical steps of a consultation: 1) Diagnostic statement; 2) treatment options discussion; 3) decision-making. Each scenario was presented according to SDM process. For each step, interviewee was argued 3 questions: (a) To identify weather each part was similar to his/her clinical encounter or not; (b) to define whether SDM can be a feasible approach and (c) to answer if he/she wanted to be assisted in SDM process, justifying it. The outcomes were defined by the justification about the willingness for SDM. Descriptive and multiple correspondence analysis (MCA) techniques were performed to explore data.

Results: Demographic data (N=160): 89% female, 60% < 8 years of school, 76% < 3 folds the minimum wage (income), 24.3% employed and 10.6%, retired due to the disease; 75% of participants had a rheumatic diagnosis clearly defined, of which 48.8% had < 4 years of diagnosis and 30%, > 8 years of diagnosis. The first scenario showed that 97% would like to have SDM approach on their real clinical practice. They justified its desire according to ‘communication empowerment’ (75%) and ‘patients’ right relationship’ (23%). For the scenario two, 98% would like to have this approach, although 65% declared that it never happen in his/her real life. They justified according to ‘communication empowerment’ (63%)’. Decision-making scenario showed that 65% of the participants never took part in the decision process. However, 98% would like to do it, justifying according to ‘patients’ right relationship’ (30%), and ‘communication empowerment’ (28%). Despite these answers, 13% answered that the whole decision belongs to the physician because they have the technical knowledge. MCA plot illustrates that diagnostic statement correlates to ‘communication empowerment’, retired because of disease, and low literacy. To understand treatment option, communication empowerment and a practice of a patient’s right was correlated with those who had < 4 years of diagnosis or > 8 years; > two rheumatic conditions, and low literacy. Finally, the desire for SDM was correlated among ‘communication empowerment’ and ‘patient’s right’ with those with < 4 years of diagnosis, active working status, and age between 50 - 59 years-old.

Conclusion: Communication empowerment and patient’s right were the most common reasons for the willingness for SDM. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/shared-decision-making-in-secondary-care-rheumatologic-patients-perspective/