Background/Purpose: Shared decision-making (SDM), in which the physician and patient work together through all phases of the decision-making process, has been of increasing significance. But the previous studies reported not all patients preferred SDM. This study explored rheumatoid arthritis (RA) patients’ preferences and experiences for participation in treatment decision making at the Japanese rheumatology clinics. In addition, we examined how often their actual roles matched their desired roles, and whether the concordance between actual and desired roles was associated with trust in physicians.              

Methods: A cross-sectional study was performed using a self-administered anonymous questionnaire between October and December 2010 on 406 RA outpatients who consecutively visited 3 hospitals in Japan. The following variables were investigated; (1) the patients’ actual roles; their experiences when the current DMARDs were decided. (2) The patients’ desired roles; their preferences for participation in treatment decision making. The patients were asked to choose one actual and one desired role of the following three options; #1 passive role; your doctor chooses the best drug for you.  #2 collaborative role; you and your doctor decide the drug together.  #3 active role; you choose the best drug and recommend it to your doctor. (3) patient’s trust in the physicians and adherence to the treatment. (4) patients’ evaluations of physician’s attitudes of patient-centeredness. (5) the demographic data (e.g. age, gender, and educational status) and the RA-specific characteristics including the past and current use of disease modifying anti-rheumatic drugs (DMARDs). Multivariate analyses were used to assess the relationship between matching of patients’ actual and desired roles and patients’ trusts.

Results: The response rate was 58.6%. 82% were women, and the mean age was 65.1 ± 10.1 years. 26.8% of the patients perceived that the doctor chose the DMARDs for them. However, the majority (62%) of the patients preferred to collaborate with their doctors in making the treatment decision. The patients who want the passive roles in the decision making were more likely to have their preferences met than patients who wish to collaborate the doctors (98% vs. 42%, p<0.01). The overall concordance rate was 62%.  In multivariate analyses, patients’ attitudes of patient-centeredness and the concordance between patients' actual and desired roles were independent predictors of trust in physicians.

Conclusion: Physicians need to assess the decision making preferences on an individual basis to gain the patients’ trust in physicians.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/matching-of-patients-actual-and-desired-roles-in-treatment-decision-making-and-trust-in-physicians/