JAPANESE PHYSICIANS' PREFERENCES FOR DECISION-MAKING IN RHEUMATOID ARTHRITIS TREATMENT

Purpose: We once reported the majority of Japanese patients with rheumatoid arthritis (RA) desired to collaborate with the physicians in making treatment decisions. However, only half of patients could share the decision-making. There are few studies on physicians’ preferences for treatment decision-making. The purposes of this study was to determine 1) Japanese physicians’ preferences for RA treatment decision-making; and 2) physicians’ recognitions about shared decision-making (SDM).

Method: An internet survey was completed by 157 Japanese physicians who were treating RA patients in March 2012. The questions were following: (1) which is your attitude when you decide RA treatment in outpatient setting? Four options were offered: “you select a treatment for your patient on the basis of what you think is best” (paternalism); “you tell several options for your patient and make a decision for her”; “you discuss options with your patient and then come to a decision together.”(SDM); and “you let your patient decide her treatment after telling some options.”  (2) How important is the patient’s information for you to decide the treatment? The information includes patients’ age, swelling joint count, laboratory findings, ADL, and patients’ preferences for decision-making. Each of items was responded on 5-point Likert scale.

Result: 92% of responders were men. 57% was veteran clinicians who worked more than 20 years. Specialties of responders were internist specialty 58%, orthopedics 31%, and rehabilitation 11%. 64% worked at hospitals and the others worked at clinics. 52% of physicians answered provision of information on treatments was the most important, and 41% answered consultation with patients was the most important. In terms of physicians’ role in decision-making, 39% stated they discussed several treatment options with their patients and selected one for them. 26% stated they shared the decision-making with their patients.

Conclusion: SDM requires an agreement of patients and physicians. While Japanese physicians know the importance of information and consultation with their patients, only a quarter of physicians shared the decision-making with their RA patients. In the future, we want to survey the barrier for SDM.