Objectives Although shared decision making (SDM) is advocated in rheumatoid arthritis (RA) treatment, it is largely unclear when, how and to what extent SDM is applied in routine clinical care of patients with RA. This study aimed to investigate the level of SDM in RA treatment from an observer perspective and to assess associations between the level of SDM and characteristics of the clinician, patient and consultation.
Methods The level of SDM was investigated by scoring audio-recordings of 168 routine consultations with unique patients with the observer patient involvement (OPTION) scale (scale 0–100, higher OPTION scores indicating higher levels of SDM). Associations between the level of SDM and characteristics of the clinician, patient and consultation were assessed using multilevel modelling. Statistical significance was set at p<0.05.
Results The mean OPTION score was 28.3 (SD=15.1). The multilevel model included four characteristics: clinician age, patient age, consultation duration and type of treatment decision. There were significant, positive associations between the level of SDM and the consultation duration (b=0.63, 95% CI 0.16 to 1.11), decision for stopping and/or starting medication (b=14.30, 95% CI 5.62 to 22.98), decision for adjusting medication doses (b=8.36, 95% CI 3.92 to 12.81) and decision for administering single dose glucocorticoids (b=15.03, 95% CI 9.12 to 20.93). Thus, a higher level of SDM was significantly associated with a longer consultation duration and the type of treatment decision. No other significant associations were found.
Conclusions Overall, the level of SDM in RA treatment leaves room for improvement. To foster SDM in routine clinical care, training programmes on patient-centred communication skills may be helpful.
- rheumatoid arthritis
- qualitative research
- DMARDs (synthetic)
- DMARDs (biologic)
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Handling editor Josef S Smolen
Contributors EGEM: study conception and design, collection of data (scoring the audio-recorded consultations), analysis and interpretation of data, drafting and critical revision of the manuscript, and approval of the final version of the manuscript. JEV: study conception and design, analysis and interpretation of data, critical revision of the manuscript, and approval of the final version of the manuscript. CDP: analysis and interpretation of data, critical revision of the manuscript, and approval of the final version of the manuscript. BJFvdB: study conception and design, acquisition of data, analysis and interpretation of data, and critical revision of the manuscript. FK: collection of data (scoring the audio-recorded consultations).
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The medical research ethical committee of Arnhem-Nijmegen, the Netherlands, waived ethical approval since this study was not subject to the medical research involving human subjects act (file number 2018–4180).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.