0190: Effect of Shared Decision-making on Trust in Physician in the Clinical Practice of Systemic Lupus Erythematosus: The TRUMP²-SLE Study

Ryusuke Yoshimi¹, Chiharu Hidekawa², Natsuki Sakurai³, Nobuyuki Yajima⁴, Noriaki Kurita⁵, Naoki Suzuki³, Yuji Yoshioka³, Daiga Kishimoto⁶, Noriko Kojitani³, Yumiko Sugiyama³, Yosuke Kunishita⁷, Kana Higashitani³, Yuji Uzawa³, Yuichiro Sato³, Soichiro Adachi³, Yuki Iizuka³, Ayaka Maeda³, Lisa Hirahara³, Takaaki Komiya³, Yutaro Soejima³, Naoki Hamada³, Hideto Nagai³, Naomi Tsuchida³, Kaoru Takase-Minegishi³, Yohei Kirino³, Nao Oguro⁴, Keigo Hayashi⁸, Kenta Shidahara⁸, Yoshia Miyawaki⁸, Ken-ei Sada⁹, Dai Kishida¹⁰, Takanori Ichikawa¹¹, Yasuhiro Shimojima¹⁰, Yuichi Ishikawa¹², Shigeru Ohno¹³ and Hideaki Nakajima³, ¹Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Kanazawa Ward, Yokohama Kanagawa, Japan, ²Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama City, Kanagawa Prefecture, Japan, ³Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan, ⁴Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan, ⁵Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan, ⁶Center for Rheumatic Diseases, Yokohama City University Medical Center, Kanazawa-ku Yokohamashi, Japan, ⁷Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan, ⁸Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan, ⁹Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Okayama, Japan, ¹⁰Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan, ¹¹Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, ¹²First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu Fukuoka, Japan, ¹³Center for Rheumatic Disease, Yokohama City University Medical Center, Yokohama, Japan

Background/Purpose: In recent years, one of the overarching principles of EULAR recommendation is that systemic lupus erythematosus (SLE) treatment should be based on shared decision-making (SDM) between patients and physicians. However, it is unclear whether the degree of involvement of SLE patients in SDM contributes to their level of trust in their physicians. In this multicenter study, we investigated the relationship between the degree of involvement in SDM and the level of trust in physicians.

Methods: We collected data on the SDM-Q-9 shared decision-making scale (range 0-100), the Trust in Physician scale (TIPS; range 0-100), the Abbreviated Wake Forest Physician Trust Scale (A-WFPTS) for interpersonal trust in a physician (range 0-100), and the A-WFPTS for trust in the medical profession (range 0-100), in SLE patients aged 20 years or older who met the 1997 ACR revised classification criteria and were attending five facilities in Japan. We cross-sectionally examined the association between the SDM-Q-9 and each trust scale. In multiple regression analysis, we used age, sex, disease duration, SLE disease activity index, annual income, level of education, and marital status as adjusting variables, and missing values were complemented by multiple imputations.

Results: A total of 386 SLE patients (age 46.2 ± 14.3 years, 88.3% female) completed the questionnaire of this study. The SDM-Q-9 was positively correlated with three trust scales, TIPS, A-WFPTS for interpersonal trust in a physician, and A-WFPTS for trust in the medical profession (Spearman rank correlation coefficient r_s = 0.64 [95%CI 0.57-0.70], p < 0.0001, r_s = 0.69 [95%CI 0.63-0.74], p < 0.0001, and r_s = 0.47 [95%CI 0.39-0.55], p < 0.0001, respectively). When 351 patients who did not have missing data in SDM-Q-9 and TIPS were divided into two groups, the higher SDM group (185 patients, median 87 [IQR 80-96]) and the lower SDM group (166 patients, 60 [51-67]), the higher SDM group had significantly higher TIPS than the lower SDM group (75 [68-82] vs. 66 [59-68], p < 0.0001). Multiple regression analysis showed that TIPS increased by 2.74 (95%CI 2.32-3.15, p < 0.001) for every ten increases in SDM-Q-9. Similarly, a multiple regression analysis of 366 patients who did not have missing data in SDM-Q-9 and A-WFPTS for interpersonal trust in a physician showed that A-WFPTS increased by 5.08 (95%CI 4.40-5.75, p < 0.001) for every ten increases in SDM-Q-9. Multiple regression analysis of 369 patients who did not have missing data in SDM-Q-9 and A-WFPTS for trust in the medical profession showed that A-WFPTS increased by 4.24 (95%CI 3.30-5.19, p < 0.001) for every ten increases in SDM-Q-9.

Conclusion: The degree of involvement of SLE patients in SDM was associated with their trust in their physicians and doctors in general.


Disclosures: R. Yoshimi, None; C. Hidekawa, None; N. Sakurai, None; N. Yajima, None; N. Kurita, None; N. Suzuki, None; Y. Yoshioka, None; D. Kishimoto, None; N. Kojitani, None; Y. Sugiyama, None; Y. Kunishita, None; K. Higashitani, None; Y. Uzawa, None; Y. Sato, None; S. Adachi, None; Y. Iizuka, None; A. Maeda, None; L. Hirahara, None; T. Komiya, None; Y. Soejima, None; N. Hamada, None; H. Nagai, None; N. Tsuchida, None; K. Takase-Minegishi, Gilead, Daiichi Sankyo, Mitsubishi Tanabe; Y. Kirino, None; N. Oguro, None; K. Hayashi, None; K. Shidahara, None; Y. Miyawaki, None; K. Sada, None; D. Kishida, None; T. Ichikawa, None; Y. Shimojima, None; Y. Ishikawa, None; S. Ohno, None; H. Nakajima, None.