ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 2605

Clarifying Misbeliefs & Resolving Decisional Conflicts About Hydroxychloroquine (HCQ) Through a Shared Decision-Making Tool (HCQ-SAFE©)

Shivani Garg1, Jay Patel1, Sancia Ferguson2, Betty Chewning3, Shelby Gomez4, Jon keevil5, David Gazeley6, Patricia Tellez-Giron1 and Christie Bartels7, 1University of Wisconsin, School of Medicine and Public Health, Madison, Madison, WI, 2University of Wisconsin, Madison, Madison, WI, 3University of Wisconsin, School of Pharmacy, Madison, 4UW Health, Madison, 5N/A, Madison, 6Medical College of Wisconsin, Wauwatosa, WI, 7University of Wisconsin School of Medicine and Public Health, Madison, WI

Meeting: ACR Convergence 2024

Keywords: Decision analysis, Health Services Research, Measurement Instrument, Systemic lupus erythematosus (SLE)

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Monday, November 18, 2024

Title: Abstracts: Health Services Research II

Session Type: Abstract Session

Session Time: 3:00PM-4:30PM

Background/Purpose: Treatment of lupus (or SLE) is complex, especially for young patients who are committed to take hydroxychloroquine (HCQ) lifelong, which carries some risk, albeit low, of eye toxicity. Patients face difficult decisions balancing risks vs. benefits, and decision-making is even harder for patients with limited literacy and English proficiency (LEP). Unable to weigh benefits vs. rare risks of HCQ, patients with limited literacy and LEP may have greater risk aversion leading to nonadherence and worse outcomes contributing to health disparities in lupus. Shared decision-making (SDM) tools could address this problem by supporting patient-clinician communication, and patient’s participation in decision-making. We examined the efficacy of a tool (HCQ-SAFE©) to engage patients in SDM to resolve decisional conflicts around HCQ in SLE.

Methods: HCQ-SAFE© is a 5-domain pictorial paper tool that highlights benefits vs. harms of HCQ to support SDM (Garg 2023). In this study, we first developed culturally appropriate e-versions of HCQ-SAFE© in English and Spanish via a collaborative process involving 28 advisors: patients from multiethnic backgrounds and LEP (n=12), clinicians working in diverse practices (n=8), implementation scientists (n=2), designers (n=2), interpreters (n=2), & health literacy experts (n=2). We used an iterative process to revise subsequent prototypes to incorporate advisors’ feedback and deliver final e-versions in English & Spanish which were endorsed by all advisors (Fig 1A-B).

To test the effectiveness of e-versions of HCQ-SAFE© in addressing decisional conflicts, we recruited adults with SLE on HCQ across 5 clinics. We used low literacy version of decisional conflict scale (DCS) to calculate DCS scores (range: 0 (best) – 100 (worst); scores ≥25 indicate clinically significant residual decisional conflict). We compared change in DCS scores pre- vs. post-intervention using linear regression adjusting for covariables (e.g., education, preferred language, clinician type, binary status of high DCS ≥25 at baseline).

Results: Among 90 participants, 90% were women, 12% preferred Spanish, 54% had high decisional conflicts at baseline. MDs, RNs, and pharmacists completed 51%, 12%, and 37% completed SDM during visits. After reviewing HCQ-SAFE©, a 29-point reduction in DCS scores was seen in all patients (p < 0.001; Fig 2A). Significant reductions were seen in DCS scores when stratified by language (Fig 2B), clinician type (Fig 2C), & highest education level (Fig 2D). In patients with high DCS (≥25) at baseline, a 49-point decrease in DCS (95% CIs -42, -54, p < 0.0001) was noted after reviewing HCQ-SAFE©. Even after adjusting, a 39-point reduction in DCS was noted post-intervention in patients with high DCS at baseline (Table 1). Median time spent by clinicians to review HCQ-SAFE© during visits was 5 mins (IQR 5-10). 

Conclusion: Our HCQ-SAFE© tool provides clear, concise, pictorial information, that improved patient understanding and reduced decisional conflicts across diverse populations, including those who are at higher risk of poor outcomes. SDM tools like HCQ-SAFE© can effectively mitigate issues arising from linguistic clarity and lack of decision support.

Supporting image 1

Fig 1. Panel A. Collaborative & iterative process to develop e-versions of HCQ-SAFE in English & Spanish; Panel B. Final e-version of HCQ-SAFE© in English and an option to translate to Spanish version.

Supporting image 2

Figure 2. Decisional conflict scores pre- and post-intervention (HCQ-SAFE© review) in A) all patients (n=90); B) by preferred language (English vs. Spanish); C) by clinician type (MD vs. PharmD/RN); D) by highest education level reported by patients (Declined to answer vs. High School vs. College/Higher)

Supporting image 3

Table 1. Multivariable Linear Regression Modelling Showing Change in Decisional Conflict Scores After Reviewing HCQ-SAFE©


Disclosures: S. Garg: None; J. Patel: None; S. Ferguson: None; B. Chewning: None; S. Gomez: None; J. keevil: None; D. Gazeley: None; P. Tellez-Giron: None; C. Bartels: None.

To cite this abstract in AMA style:

Garg S, Patel J, Ferguson S, Chewning B, Gomez S, keevil J, Gazeley D, Tellez-Giron P, Bartels C. Clarifying Misbeliefs & Resolving Decisional Conflicts About Hydroxychloroquine (HCQ) Through a Shared Decision-Making Tool (HCQ-SAFE©) [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/clarifying-misbeliefs-resolving-decisional-conflicts-about-hydroxychloroquine-hcq-through-a-shared-decision-making-tool-hcq-safe/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/clarifying-misbeliefs-resolving-decisional-conflicts-about-hydroxychloroquine-hcq-through-a-shared-decision-making-tool-hcq-safe/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology