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14-05-2019 | Rheumatology | News | Article

Individualized tool aids treatment decision-making for women with lupus nephritis

medwireNews: SMILE, an individualized and culturally tailored patient decision aid, has been shown to reduce decisional conflict regarding choice of immunosuppressive treatment in a randomized trial involving a diverse group of women with lupus nephritis.

“In the U.S., 41% of Hispanic groups, 24% of African-Americans, and 9% of whites have below basic health literacy skills,” which “may interfere with the delivery of guideline-concordant care in racial/ethnic minorities with lupus,” explain Jasvinder Singh (University of Alabama at Birmingham, USA) and fellow researchers.

“Decision aids that address patients’ literacy and numeracy levels are therefore warranted,” they say.

The IDEA-WON (Individualized Decision aid for Diverse Women with Lupus Nephritis) trial included 298 women with lupus nephritis, of whom the majority were of non-Hispanic Black (47.3%) or Hispanic/Latino (26.2%) ethnicity, and 35.6% were educated to high school level or lower.

As reported in PLOS Medicine, the 151 participants who were randomly assigned to use the SMILE (shared decision-making in lupus electronic tool) decision aid reported an average 21.8-point reduction in the Decisional Conflict Scale (DCS) score after using the tool on tablet computers in clinic waiting rooms.

This was significantly greater than the average reduction of 12.7 points for the 147 women in the control group who were instead given a standard ACR patient information leaflet on lupus and its treatment.

Moreover, Singh and colleagues say that prespecified subgroup analyses showed a “clinically meaningful and statistically significant reduction” in average DCS score with the decision aid versus usual care among participants with a low household income (<US$ 40,000 [€ 35,612]) and low graphic literacy.

However, there was no significant difference in the co-primary outcome, with a similar proportion of patients in the SMILE and control groups reporting having made an informed choice regarding immunosuppressive treatment, at 41.1% and 31.3%, respectively.

Patient–physician communication, as measured using the Interpersonal Processes of Care short form survey, was also comparable between the two groups, with corresponding mean scores of 83.6 and 83.1 points on an 18–90-point scale, with higher scores indicating better communication.

With regard to patient education, the researchers found that a significantly greater proportion of patients in the decision aid versus the control group rated the information as “excellent” for understanding the impact of and risk factors for lupus nephritis, as well as the treatment options, evidence supporting medications, and information about other patients.

Taken together, the findings from this study provide evidence that the SMILE decision aid “may help patients feel more confident in their treatment choices,” write Singh and team.

They say that “SMILE will be available free of cost in the public domain and can be administered using any touchscreen computer.”

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

PLoS Med 2019; 16: e1002800

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