Purpose: Patients are frequently reluctant to adjust their treatment. To better understand the factors that impact patient-level barriers and facilitators to escalating care, we used a concurrent think aloud approach to gain insight in real time into how patients' approach trade-offs between the specific risks and benefits related to medications.
Methods: 88 patients with RA were audiotaped as they performed an Adaptive Conjoint Analysis (ACA) survey. ACA examines how participants value incremental risk and benefits using a series of paired comparison tasks. Transcripts were analyzed using the constant comparative method of grounded theory. We developed a conceptual model based on participants' verbalizations.
Results: Participants' mean (SD) age was 55 (13); 68% were Caucasian, 68% were women, and one third had a college degree or more. Participants varied in their level of both disease and medication induced stress and consequently, in how open they were to considering alternative choices (Figure 1). Those who were significantly physically and/or emotionally stressed by factors related to their disease or to medications voiced an absolute need to change or to stay with their current status quo, respectively. For these participants trade-offs between competitive options were, in effect, immaterial. In contrast, participants who were not as strongly stressed were more open to considering their available options. Among these participants, we noted that risk-benefit trade-offs were modified by sociodemographic characteristics, personal responsibilities, as well as physician-related factors.
Conclusions: The proposed relationship between disease or medication-related stress and open-mindedness is akin to the Yerkes-Dodson Law describing an inverted U-shaped curve relationship between arousal and performance. Patients are unlikely to be interested in considering alternatives at low levels of stress, and our data suggest that they are unwilling to consider alternatives outside of their preference for or against the status quo when highly stressed. In contrast, those with modest levels of disease-related stress are most likely to be willing to consider the trade-offs associated with alternative treatment options. These findings have implications for how shared decision making may be best implemented in clinical practice.
See more of: The 35th Annual Meeting of the Society for Medical Decision Making