English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis
English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis
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DOI：
10.3899/jrheum.131350
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发表时间：
2014-07-01
影响因子：
3.9
通讯作者：
Yelin, Edward
中科院分区：
文献类型：
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作者：
Barton, Jennifer L.;Trupin, Laura;Yelin, Edward
Objective.靶向治疗指南促进类风湿关节炎（RA）的共同决策（SDM）。此外，由于治疗的高成本和潜在毒性。SDM是患者安全的核心。我们的目的是研究2组RA患者的决策沟通模式。数据来自2个纵向观察性队列之一[加州大学弗朗西斯科分校（UCSF）RA队列和RA队列]入组的患者。受试者完成了他们的首选语言，其中包括一个病人提供沟通的措施，包括有关决策项目的电话采访。还询问了对医生、教育和语言能力的信任度。进行逻辑回归以确定次优SDM沟通的相关性。对每种样品分别进行分析。在2个队列的509例患者中，30%和32%报告了次优SDM通信。在两个队列中，对医生的低信任与次优SDM沟通独立相关。在UCSF RA队列中，年龄较大和英语水平有限与次优SDM独立相关，在RA小组队列中，健康素养有限也是如此。这项对来自2个人口统计学上不同的队列的500多名RA成人的研究发现，无论哪个队列，近三分之一的受试者报告与其临床医生的SDM沟通不佳。在两个队列中，对医生的信任度较低与次优SDM沟通独立相关，加州大学旧金山分校RA队列中的英语水平有限和年龄较大，RA小组队列中的健康素养有限。这些发现强调了需要检查SDM对RA健康结果的影响。
Objective. Treat-to-target guidelines promote shared decision making (SDM) in rheumatoid arthritis (RA). Also, because of high cost and potential toxicity of therapies. SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision making in 2 cohorts of adults with RA.Methods. Data were derived from patients enrolled in 1 of 2 longitudinal, observational cohorts [University of California, San Francisco (UCSF) RA Cohort and RA Panel Cohort]. Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision making. Measures of trust in physician, education, and language proficiency were also asked, Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately.Results. Of 509 patients across 2 cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel Cohort.Conclusion. This study of over 500 adults with RA from 2 demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the RA Panel Cohort. These findings underscore the need to examine the influence of SDM on health outcomes in RA.