IMPACT OF DECISION-MAKING ROLE PREFERENCES IN THE EFFICACY OF A MULTIMEDIA PATIENT EDUCATION TOOL FOR PATIENTS WITH COMMON RHEUMATOLOGIC CONDITIONS

Purpose: A preference for shared decision-making among patients with chronic conditions has been associated with better health outcomes. We evaluated the effects of a multimedia patient education tool (MM-PtET) compared to a written booklet with the same information in patients with rheumatic diseases.

Method(s): Patients were recruited from 5 centers and through advertisement. Inclusion criteria were: (i) age ≥18 years (ii) diagnosis of rheumatoid arthritis (RA), knee osteoarthritis (OA), or osteoporosis/osteopenia (OP) (iii) adequate cognitive status and, (iv) ability to communicate in English or Spanish language. Our primary outcome was disease knowledge and secondary measures included decisional conflict, self-efficacy and disease management. Assessments were conducted before and after viewing MM-PtET, at 3 and 6 months. The Control Preference Scale (CPS) was used to characterize participants according to their preferred role in decision making (passive vs shared vs active role). 

Result(s): 665 participants were randomized (331=MM-PtET, 334=written booklet). Mean age was 59.8±12.1 years, 87% were female, 65% non-White, 20% had inadequate health literacy levels and 26% answered the questionnaire in Spanish. Thirty-three percent had a diagnosis of OA, 34% OP, and 33% RA; 472 (232=MM-PtET, 240=booklet) and 522 (257=MM-PtET, 265=booklet) participants returned their questionnaires at 3 and 6 months, respectively.  Most patients reported an active decision-making role preference in the intervention (48% active, 36% shared, and 15% passive) and control (47% active, 36% shared, 17% passive) groups.  Greater knowledge scores were observed after viewing the MM-PtET compared with reading the booklet in patients with a shared role preference (p=0.04).  Compared to patients in the control group, patients in the intervention group with a passive role preference had less decisional conflict (p=0.04) and better decision management (p=0.02) at 3 months. However, at 6 months improvements from baseline were only significant for patients with an active (decisional conflict, p=0.04) and shared role preference (disease management, p=0.03). Univariate analysis showed that greater improvements in knowledge (regardless of assignment) were associated with passive role preference compared to active (p=0.001, pre&post; p=0.03, pre&6-month) and shared role (p=0.01) preference.

Conclusion(s): Our MM-PtET improved outcomes after intervention, 3 and 6 months. However, the benefits varied according to the decision-making role preference.  Given the observed differences, it is important that educational interventions are tailored to the patients’ preferences about their involvement in the decision-making processes.