THU0651 AN INDIVIDUALIZED DECISION-AID FOR DIVERSE WOMEN WITH LUPUS NEPHRITIS (IDEA-WON): A RANDOMIZED CONTROLLED TRIAL 
Authors: jasvinder singh, Liana Fraenkel, Candace Green, Graciela S Alarcon, Jennifer Barton, Kenneth Saag, Leslie Hanrahan, Sandra Raymond, Robert Kimberly, Amye Leong, Elyse Reyes, Richard Street, Maria Suarez-Almazor, Guy Eakin, Laura Marrow, Charity Morgan, Brennda Caro, Jeffrey Sloan, Bochra Jandali, Salvador Garcia, Jennifer Grossman, Kevin Winthrop, Laura Trupin, Maria Dall’era, Alexa Meara, Tara Rizvi, Winn Chatham, Jinoos Yazdany
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Medication decision-making is challenging in lupus. No validated, effective decision-aids are available to assist patients with medication decision-making. <h3>Objectives</h3> Our objective was to assess the effectiveness of an individualized, culturally-tailored, computerized decision-aid for immunosuppressive medications for lupus nephritis. <h3>Methods</h3> In a multicenter, randomized controlled trial, diverse adult women with lupus nephritis, largely racial/ethnic minorities with low socio-economic status, were randomized to decision-aid vs. American College of Rheumatology lupus pamphlet (1:1 ratio). Co-primary outcomes were change in decisional conflict and informed choice regarding immunosuppressive medications. <h3>Results</h3> Of 301 randomized women, 47% were African-American, 26% were Hispanic, and 15% White. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of &lt;$40,000, and 36% had a high-school education or less. Compared to the pamphlet (n=147), participants randomized to the decision-aid (n=151) had: (1) a clinically meaningful and statistically significant larger decrease in decisional conflict, 21.8 (standard error [SE], 2.5) vs. 12.7 (SE, 2.0; p=0.005); and (2) a clinically meaningful difference in informed choice, statistically non-significant in the main analysis, 41% vs. 31% (p=0.08), but significant in sensitivity analysis (net values for immunosuppressives positive [in favor] vs. negative [against]), 50% vs 35% (p = 0.006). Respectively, unresolved decisional conflict post-intervention was significantly lower, 22% vs. 44% (p&lt;0.001). Significantly more patients in decision-aid vs. pamphlet group rated information to be excellent for understanding lupus nephritis (49% vs. 33%), risk factors (43% vs. 27%), medication options (50% vs. 33%; p≤0.003 for all); and the ease of use of materials higher (51% vs. 38%; p=0.006). <h3>Conclusion</h3> An individualized decision-aid was effective in reducing decisional conflict for immunosuppressive medications in diverse women with lupus nephritis. <h3>Disclosure of Interests</h3> jasvinder singh Shareholder of: Amarin pharmaceuticals and Viking therapeutics, Consultant for: Crealta/Horizon, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology, Liana Fraenkel: None declared, Candace Green: None declared, Graciela S Alarcon: None declared, Jennifer Barton: None declared, Kenneth Saag Grant/research support from: Amgen, Ironwood/AstraZeneca, Horizon, SOBI, Takeda, Consultant for: Abbvie, Amgen, Ironwood/AstraZeneca, Bayer, Gilead, Horizon, Kowa, Radius, Roche/Genentech, SOBI, Takeda, Teijin, Leslie Hanrahan: None declared, Sandra Raymond: None declared, Robert Kimberly: None declared, Amye Leong: None declared, Elyse Reyes: None declared, Richard Street: None declared, Maria Suarez-Almazor : None declared, Guy Eakin: None declared, Laura Marrow: None declared, Charity Morgan: None declared, Brennda Caro: None declared, Jeffrey Sloan: None declared, Bochra Jandali: None declared, Salvador Garcia: None declared, Jennifer Grossman: None declared, Kevin Winthrop Consultant for: Gilead, Galapagos, Eli Lilly and Company, Abbvie, Pfizer, GSK, Laura Trupin: None declared, Maria Dall'Era Grant/research support from: University has received funds to serve as a site on this clinical study, Consultant for: On Data Monitoring Committee for Janssen, Biogen, and Genentech; on Steering Committee for EMD Serono., Alexa Meara: None declared, Tara Rizvi: None declared, Winn Chatham: None declared, Jinoos Yazdany Grant/research support from: Pfizer, Consultant for: AstraZeneca