Background/Purpose: Medications play an important role in the management of rheumatoid arthritis.  Principles of informed consent, informed and shared decision-making, and professional ethics highlight the importance of patients’ understanding both the risks and benefits of different treatment options. Thus, the work described in this presentation is designed to increase current understanding of patient-rheumatologist communication about the risks associated with medications used to manage rheumatoid arthritis

Methods: We are content analyzing approximately 1000 audiotapes of rheumatoid arthritis patient-rheumatologist office visits that were collected in a previous study.  The current study is guided by fuzzy-trace theory. This theory suggests that when an individual is exposed to information (e.g., a statement made by one’s physician) two representations of the information are encoded in memory, a verbatim representation and a gist representation. Verbatim representations capture the precise information that was provided; whereas, gist representations reflect the essential meaning of the information to the person, including its emotional meaning. A central tenet of fuzzy-trace theory is that, when making judgments and decisions, people tend to rely on gist representations that are stored in memory and retrieve verbatim representations only when required by the task at hand. Thus, using fuzzy-trace theory as a guiding framework, we have developed a detailed 2-level coding scheme that captures the types of information concerning medication and disease risks that may be exchanged between patients and rheumatologists during office visits.

Results: A total of 3588 medication risks were identified in the transcripts. The most common medication risks were: methotrexate-GI problems (n=219); methotrexate-mouth/nose sores (n=190); methotrexate-need to monitor, but labs not specified (n=167); methotrexate-liver toxicity (n=141); methotrexate-pulmonary problems (n=109); and prednisone-implied risks by desire to minimize exposure to the medication (n=167).  An average of 3.87 medication risks were discussed per office visit.  Lower patient medication satisfaction was associated with: discussion of more medication risks (p < 0.03), patient and physician expression of medication safety concerns (p’s < 0.05 and 0.0001, respectively) and lack of patient and physician endorsement of medication need/efficacy (p’s < 0.0001 and .03, respectively). 

Conclusion: By examining the manner in which medication and disease risks are discussed in combination, the findings from this study promise to provide a richer understanding of the risk communication that takes place during rheumatology office visits.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-rheumatologist-communication-concerning-medication-and-disease-risks/