Shared Decision Making Elevates Trust in Patients with SLE

Engagement of patients with systemic lupus erythematosus (SLE) in shared decision-making increases patient trust in their clinicians and healthcare providers, which may enhance doctor-patient relationships and overall trust in healthcare, according to research published in Arthritis Care & Research.¹

Shared decision-making has become a critical principle in the recommendations and guidelines of the European Allience of Associations for Rheumatology (EULAR) since 2019 as it helps patients who need treatment modifications during periods of exacerbation and remission to attain their treatment goals.²

“Trust in physicians is central to medical care, as it aids in maintaining medication adherence among patients with SLE,” wrote a group of investigators led by Ryusuke Yoshimi MD, PhD, senior assistant professor at Yokohama City University School of Medicine in Japan. “Good shared decision-making is associated with trust in the physician among patients with lupus nephritis. However, this association may have been confounded by education and disease activity… Thus it is necessary to verify the effect of physicians’ efforts to promote shared decision-making on patients’ trust in physicians, both interpersonally and generally, via a well-designed study.”

To understand if shared decision-making is beneficial to SLE management, investigators conducted the Trust Measurement in Physicians and Patients with SLE (TRUMP2-SLE) study. They collected information from Trust in Physician Scale (TIPS) scores, 9-item Shared Decision-Making Questionnaire (SDM-Q-9) scores, and the Abbreviated Wake Forest Physician Trust Scale (A-WFPTS) scores for interpersonal trust in a physician and trust in the medical profession. Eligible patients were aged ≥ 20 years, satisfied the 1997 American College of Rheumatology (ACR) revised classification criteria, received care at 1 of 5 participating outpatient clinics in Japan, and were able to complete the questionnaire survey between June 2020 and August 2021. General linear models with cluster-robust variance analyzed the scores of these self-administered questionnaires.

Ultimately, 433 subjects participated in the study, with a mean age of 46.8 years. Most (87%, n = 378) patients were women and the median disease duration was 12.6 years. More than half of participants were seen by an attending clinician for ≥ 3 years.

The median baseline TIPS score was 82 (73 – 93) and the A-WFPTS score was 80 (70 – 95). A higher baseline SDM-Q-9 score was linked to an increase in the TIPS score at the 1-year mark (coefficient per 10-pt increase, .94 pt [95% confidence interval (CI) .16 – 1.72]). Additionally, a higher SDM-Q-9 score was linked to a higher A-WFPTS score for interpersonal trust (coefficient per 10-pt increase, 2.20 pt [1.44 – 2.96]). The baseline SDM-Q-9 score was correlated with an increase in the general physician version of the A-WFPTS score at the 1-year mark (coefficient per 10-pt increase, 1.29 pt [0.41 – 2.18]).

Investigators noted limitations including the fact that the causal relationship between shared decision-making and trust in clinicians was not as strong as in previous interventional studies due to the observational nature of this study design. Additionally, all facilities included in the study were university medical centers. Therefore, clinicians and patients may differ from other clinics and hospitals. However, patients with SLE in Japan usually visit specialized medical centers.

“The present study demonstrated the potential role of shared decision-making in building trust in physicians among patients with SLE, underscoring the significance of shared decision-making in ensuring confidence in decision-making in the management of SLE, where there is uncertainty regarding treatment efficacy and multiple treatment options,” investigators concluded.

References

1. ^{Yoshimi R, Yajima N, Hidekawa C, et al. Effect of shared decision-making on trust in physicians in the management of systemic lupus erythematosus: The TRUMP2-SLE prospective cohort study. Arthritis Care Res (Hoboken). Published online August 4, 2024. doi:10.1002/acr.25409}
2. ^{Ichikawa T, Kishida D, Shimojima Y, et al. Impact of online health information-seeking behavior on shared decision-making in patients with systemic lupus erythematosus: The TRUMP(2)-SLE project. Lupus. 2023;32(11):1258-1266.}