Patient decision-making related to antirheumatic drugs in rheumatoid arthritis: the importance of patient trust of physician

• Published in: Journal of rheumatology 2008-04, Vol.35 (4), p.618-624
• Main Authors: MARTIN, Richard W, HEAD, Andrew J, RENE, Jonathan, SWARTZ, Timothy J, FIECHTNER, Justus J, MCINTOSH, Barbara A, HOLMES-ROVNER, Margaret
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - psychology; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Choice Behavior; Data Collection; Decision Making; Diseases of the osteoarticular system; Female; Health Knowledge, Attitudes, Practice; Health Status; Humans; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Patient Participation - psychology; Pharmacology. Drug treatments; Physician-Patient Relations
• ISSN: 0315-162X; 1499-2752

OBJECTIVE: To explore how rheumatoid arthritis (RA) antirheumatic drug-specific knowledge and numeric literacy, patient trust in physician, and demographic and disease-related factors relate to the confidence of patient decision-making related to disease modifying antirheumatic drugs (DMARD). METHODS: Data were analyzed from 628 randomly selected patients with RA receiving care in community rheumatology practices, who responded to a multicenter, cross-sectional mail survey. We used multiple regression models to predict patient confidence in DMARD decision-making related to their most recently initiated DMARD. RESULTS: Significant positive correlation was found between confidence in DMARD decision and trust in physician, DMARD-specific knowledge, and disease duration, but not risk-related numeric literacy, sex, or education. Negative correlations were found with disease severity and current bother with DMARD side effects. A multiple linear regression model of confidence in DMARD decision had an overall R = 0.788, R2 = 0.620 (p < 0.001). The 4 dependent variables contributing significantly to the model were female sex, Medicaid insurance status, satisfaction with RA disease control, and trust in physician, with standardized beta = 0.077, -0.089, 0.147, and 0.687, respectively. CONCLUSION: In this sample of community patients with RA, the patient trust in physician had substantially greater effect on confidence in DMARD decision than DMARD-specific knowledge, disease-related factors, or demographic characteristics.