individualized patient decision making for treatment choices among minorities with lupus

Conditions: Systemic Lupus Erythematosus

Summary: the study will compare the efficacy of the usual education materials to individualized computerized decision guide on decision conflict of patients with lupus nephritis making treatment decisions regarding immunosuppressive therapies.

the proposed study, a randomized controlled trial \[rct\], will evaluate methods to assist minority lupus patients (african-americans and hispanics) to make shared decisions for the management of their lupus nephritis considering what is the best for them. we have developed an individualized patient decision guide that is culturally sensitive since it was developed solely based on the values, beliefs and preferences of minority patients. we will test the effectiveness of individualized decision aids in african-american and hispanic lupus nephritis patients in a 2-arm randomized trial including 200 patients. we hypothesize that use of decision-aid will be associated with reduction in decisional conflict and more informed choice compared to usual care group (american college of rheumatology \[acr\] lupus pamphlet; co-primary effectiveness outcomes), both clinically meaningful and patient-centered outcomes. we chose the low-literacy decisional conflict scale as our primary outcome, since it is a validated measure, and the most commonly used outcome measure in decision aids rcts. we use informed choice as a co-primary outcome, since this is conceptually most immediate to the intervention. it will measure whether in those with knowledge of risks and benefits of immunosuppressive drugs, patient values are concordant with their choice of immunosuppressive drug. secondary outcomes include patient involvement in decision-making (concordance on control preference scale) and patient-physician communication (interpersonal processes of care (ipc) score and analysis of audiotaped physician-patient interaction (using the active patient participation coding scheme (appc)). since we planned to recruit patients with current lupus nephritis flare (making current decision for an immunosuppressive drug) and with past lupus nephritis flares (making the same decision for a future lupus nephritis flare), two secondary outcomes (control preference scale for concordance of preferred and real role in deciding about immunosuppressive drugs and the audiotaped physician-patient interaction about immunosuppressive drugs) will be analyzed only in patients with current lupus nephritis flare, a subset of the entire cohort.

Eligibility criteria:
inclusion criteria: * adult female lupus nephritis patients, currently having a flare of lupus nephritis and considering change or initiation of an immunosuppressive medication (current flare) or had had flare of lupus nephritis in the past and at risk for a future lupus nephritis flare (future flare) exclusion criteria: * male; lupus but no lupus nephritis; change in lupus immunosuppressive treatment already made for current flare; end stage renal disease on dialysis; renal transplant or candidate for a renal transplant

Keywords: lupus nephritis lupus decision-making minorities immunosuppressive medications decision-aid treatment decision conflict sle