Psychosocial
Abstract 757/16 The Importance of Patient Trust of Physician in Rheumatoid Arthritis Decision Making
Authors: Richard W. Martin1, Jonathan Rene2, Andrew J. Head1, Timothy J. Swartz3, Justus J. Fiechtner4, Barbara A. McIntosh5, Margaret Holmes-Rovner4. 1Michigan State University, Grand Rapids, MI; 2Michigan State University, Saginaw, MI; 3Michigan State University, Kalamazoo, MI; 4Michigan State University, E. Lansing, MI; 5Michigan State University, Flint, MI
Purpose: To describe the personal and social factors associated with patient satisfaction with physician communication about RA medications (DMARD selection).
Methods: A random sample of 900 patients was drawn from a sampling frame of 3650 patients with RA (ICD-9 code 714.0) seen in 5 community rheumatology practices in 2005. Mail surveys were used to query patient demographics, experience with DMARD, DMARD-specific knowledge and number, disability, Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness (COMRADE) and physician trust.
Results: Overall patient response rate was 71%. Patients in this study consisted of mainly educated white females with a mean age 58 and mean HAQ II of .901. Most reported having established RA (78%) with nearly half (48%) reported past or present anti-TNF therapy.
COMRADE sub scores for both the communication and confidence scales were 42 ± 10 respectively (maximum possible score 50 each). Additional analysis yielded evidence of a single factor in this sample. Communication satisfaction (total COMRADE score) was significantly (p< .05) and directly associated with trust in the physician (r = .758), moderately associated with satisfaction with disease control (.472) and self-efficacy to manage disease (.355), weakly and directly associated with disease duration (r = .164). Age, education, and risk related numeracy, however, were not significantly associated with COMRADE. Results were essentially unchanged in adjusted analyses that included HAQII, duration of RA, minority status, DMARD knowledge or bother, and history of depression.
Conclusions: Potentially modifiable patient factors such as DMARD specific knowledge and bother by side effects decrease satisfaction with risk communication and decision. However physician trust is much more strongly predictive of satisfaction with DMARD decision making than other patient personal factors.
Editorial note: In this study, trust in one’s physician was the most potent predictor of patient satisfaction with discussions about DMARD choices. This is not surprising given that trust is central to a patient’s decision to seek care, reveal personal information, and adhere to recommended treatment plan. Indeed, Sir William Osler noted nearly 100 years ago “It is much more important to know what sort of patient has a disease than what sort of disease a patient has.”
Beyond this, two patient factors -- satisfaction with disease control and self-efficacy --are also important influences. Satisfaction with disease control has been related to two factors: receiving sufficient information about what to expect, combined with encouragement and support from the health care team. Self efficacy is the patients’ sense of control over their symptoms by having relevant knowledge and skills, as well as the ability to use these tools to obtain a desired outcome.
The development of trust between patients and their providers is increasingly compromised in an age where forces compel care providers to severely limit time spent with each patient. Ultimately, when providers are able to take the time to provide sufficient information in a personalized manner for their patients, set appropriate expectations about RA medications (how quickly to expect changes, how much change, etc.) and empower patients to utilize proven self-management strategies*, trust is strengthened and patient and provider satisfaction increases.
*The Arthritis Self-Management Program was developed by Dr. Kate Lorig of Stanford University to help people with arthritis learn and practice the different skills needed to build an individualized self-management program and gain the confidence to carry it out. To learn about ASMP programs in your area, call the local chapter of the Arthritis Foundation.