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Patient Decision-Making Related to Antirheumatic Drugs in Rheumatoid Arthritis: The Importance of Patient Trust of Physician RICHARD W. MARTIN, ANDREW J. HEAD, JONATHAN RENÉ, TIMOTHY J. SWARTZ, JUSTUS J. FIECHTNER, BARBARA A. McINTOSH, and MARGARET HOLMES-ROVNER
ABSTRACT. Methods. Data were analyzed from 628 randomly selected patients with RA receiving care in community rheumatology practices, who responded to a multicenter, cross-sectional mail survey. We used multiple regression models to predict patient confidence in DMARD decision-making related to their most recently initiated DMARD. Results. Significant positive correlation was found between confidence in DMARD decision and trust in physician, DMARD-specific knowledge, and disease duration, but not risk-related numeric literacy, sex, or education. Negative correlations were found with disease severity and current bother with DMARD side effects. A multiple linear regression model of confidence in DMARD decision had an overall R = 0.788, R2 = 0.620 (p < 0.001). The 4 dependent variables contributing significantly to the model were female sex, Medicaid insurance status, satisfaction with RA disease control, and trust in physician, with standardized ß = 0.077, -0.089, 0.147, and 0.687, respectively. Conclusion. In this sample of community patients with RA, the patient trust in physician had substantially greater effect on confidence in DMARD decision than DMARD-specific knowledge, disease-related factors, or demographic characteristics. (J Rheumatol First Release Feb 15 2008) Key Indexing Terms:
DECISION-MAKING
From the Departments of Medicine and Rheumatology, and the Center for Ethics and the Humanities in the Life Sciences, College of Human Medicine, Michigan State University, Grand Rapids, Michgan, USA. Supported by the Michigan State University College of Human Medicine Community Research Grant. R.W. Martin, MD, MA; A.J. Head, MD, Grand Rapids, MI; J. René, MD, Saginaw, MI; T.J. Swartz, MD, Kalamazoo, MI; J.J. Fiechtner, MD, MPH; M. Holmes-Rovner, PhD, East Lansing, MI; B.A. McIntosh, MD, Flint, Michigan, USA. Address reprint requests to Dr. R.W. Martin, Department of Medicine, Rheumatology College of Human Medicine, Michigan State University, 1155 East Paris NE, Ste. 100, Grand Rapids, MI 49546. E-mail: martin@mi-arthritis.com Accepted for publication November 14, 2007.
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