Japanese physicians’ preferences for decision making in rheumatoid arthritis treatment

Figures & data

Table 1 Characteristics of the respondents

Characteristic	Total n=157 (%)
Sex
Woman	13 (8.3)
Man	144 (91.7)
Duration of clinical experience
<10 years	15 (9.6)
10–19 years	52 (33.1)
≥20 years	90 (57.3)
Specialty
General medicine	46 (29.3)
Rheumatology	43 (27.4)
Orthopedics	49 (31.2)
Rehabilitation	19 (12.1)
Major place of clinical work
University hospital	37 (23.6)
Hospital	63 (40.1)
Clinic	57 (36.3)
Specialist qualifications
Yes	78 (49.7)
No of patients treated in 1 month
<10	58 (36.9)
10–49	52 (33.1)
>50	47 (29.9)

Table 2 Perceived styles of physicians’ actions

Perceived style	Physicians n (%)	Number (%) of physicians who answered “very important”
		Provide information to patients	Present multiple options to patients	Make an effort to answer questions	Discuss options with patients
Q1:1 Select a treatment for the patient	20 (12.7)	9 (45)	0 (0)	10 (50)	5 (25)
Q1:2 Present many treatment options and select one	61 (38.9)	27 (44.3)	12 (19.7)	22 (36.1)	19 (31.1)
Q1:3 Let the patient choose	34 (21.7)	18 (52.9)	16 (47.1)	17 (50)	16 (47.1)
Q1:4 Shared decision making	42 (26.8)	27 (64.3)	19 (45.2)	24 (57.1)	25 (59.5)
Total	157	81 (51.6)	47 (29.9)	73 (46.5)	65 (41.4)
P-value		0.22	<0.01	0.18	0.01

Note: Questions are listed in Table S1.

Abbreviation: Q, question.

Table 3 Physicians’ desires regarding patients’ attitudes

Perceived style	Patients, n	Have correct information	Actively research information	Number (%) of physicians who answered “strongly desired”
				Have supportive family and friends	State desires to the physician	State desires to the nurse	Ask questions	Follow the doctor’s directions
Q1:1 Select a treatment for the patient	20	7 (35)	3 (15)	4 (20)	4 (20)	1 (5)	5 (25)	9 (45)
Q1:2 Present many treatment options and select one	61	26 (42.6)	7 (11.5)	8 (13.1)	14 (23)	6 (9.8)	21 (34.4)	28 (45.9)
Q1:3 Let the patient choose	34	15 (44.1)	5 (14.7)	8 (23.5)	8 (23.5)	4 (11.8)	8 (23.5)	12 (35.3)
Q1:4 Shared decision making	42	23 (54.8)	7 (16.7)	17 (40.5)	13 (31)	12 (28.6)	20 (47.6)	28 (66.7)
Total	157	71 (45.2)	22 (14)	37 (23.6)	39 (24.8)	23 (14.6)	54 (34.4)	77 (49)
P-value		0.46	0.9	0.02	0.74	0.03	0.12	0.04

Note: Questions are listed in Table S1.

Abbreviation: Q, question.

Table 4 Univariate analysis of perceived style by physician characteristics

Characteristic	SDM 42 n (%)	Non-SDM 115 n (%)	χ^2 (df)
Sex
Woman	1 (7.7)	12 (92.3)	=3.27 (1)
Man	41 (28.5)	103 (71.5)
Duration of clinical experience
<10 years	5 (33.3)	10 (66.7)	=0.68 (2)
10–19 years	15 (28.8)	37 (71.2)
>20 years	22 (24.4)	68 (75.6)
Specialty
General medicine	7 (15.2)*	39 (84.8)*	=7.23 (3)
Rheumatology	17 (39.5)*	26 (60.5)*
Orthopedics	14 (28.6)	35 (71.4)
Rehabilitation	4 (21.1)	15 (78.9)
Major place of clinical work
University hospital	14 (37.8)	23 (62.2)	=4.96 (2)
Hospital	18 (28.6)	45 (71.4)
Clinic	10 (17.5)*	47 (82.5)*
Specialist qualifications
Yes	27 (34.6)	51 (65.4)	=4.94 (1)**
No	15 (19.0)	64 (81.0)
No of patients treated in 1 month
<10	14 (24.1)	44 (75.9)	=3.08 (2)
10–49	11 (21.2)	41 (78.8)
>50	17 (36.2)	30 (63.8)

Notes:

* Absolute value of adjusted residual >1.96;

** P<0.05.

Abbreviations: SDM, shared decision making; df, degrees of freedom.

Table 5 Physicians’ perception of the importance of various factors in deciding on a treatment

Physicians’ perception	Number of physicians who answered each option
	1	2	3	4	5	Rate of no 5 (%)	Rate of no 4+5 (%)
	Not important				Very important
Q4:11 Information about adverse effects of the treatment	0	3	6	87	61	38.9	94.3
Q4:10 Information about treatment effects	0	2	9	89	57	36.3	93.0
Q4:6 Acute-phase reactions (abnormal serum CRP or ESR)	0	2	8	91	56	35.7	93.6
Q4:3 Radiographic changes of typical erosion in the affected joints	0	2	16	83	56	35.7	88.5
Q4:8 Functional status (disability), usually assessed by HAQ score	0	2	12	94	49	31.2	91.1
Q4:2 Number of swollen or tender joints	0	2	17	92	46	29.3	87.9
Q4:5 Serum anti-CCP antibody	0	2	22	88	44	28.0	84.1
Q4:7 Activity of daily living at home, school, workplace, etc	0	2	11	103	41	26.1	91.7
Q4:12 Patients’ financial burden of treatment	0	3	16	101	37	23.6	87.9
Q4:1 Patients’ age	0	6	20	94	35	22.3	82.2
Q4:9 Patients’ preferences for treatment	0	5	24	106	22	14.0	81.5
Q4:4 Serum rheumatoid factor	0	10	41	83	18	11.5	64.3

Note: Questions are listed in Table S1.

Abbreviations: Q, question; ESR, erythrocyte sedimentation rate; HAQ, health assessment questionnaire; CRP, C-reactive protein; CCP, cyclic citrullinated peptide.

Table S1 Questions of the Internet survey

Q1	Which of the following is your usual method of deciding on a treatment for RA in the outpatient setting? Please select 1 of the 4 options.
	1	You select a treatment for your patient on the basis of what you think is best.
	2	You present multiple options to your patient but make the decision for the patient.
	3	You let your patient choose the treatment after presenting some treatment options.
	4	You discuss treatment options with your patient and then come to a decision together.
Q2	How important are the following actions for physicians when they decide on treatments? Please rate the importance on a 5-point scale (5: very important – 1: not important at all).
	1	Physicians give information about treatment to patients.
	2	Physicians present multiple treatment options to patients.
	3	Physicians make an effort to answer patients’ questions.
	4	Physicians discuss treatment options with patients.
Q3	How much do you want your patients to do the following for effective RA treatment? Please rate the importance on a 5-point scale (5: strongly – 1: not at all).
	1	Have correct information about treatments.
	2	Actively research information about treatments.
	3	Have supportive family and friends.
	4	State their desires and concerns about treatments to the physician.
	5	State their desires and concerns about treatments to a nurse.
	6	Ask medical staff questions about the disease and treatments.
	7	Follow the doctor’s directions.
Q4	How important is the following information for you to decide on a treatment? Please rate the importance on a 5-point scale (5: very important – 1: not important at all).
	1	Patient’s age
	2	Number of swollen or tender joints
	3	Radiographic changes of typical erosion in the affected joints
	4	Serum rheumatoid factor
	5	Serum anti-CCP antibody
	6	Acute-phase reactants (abnormal serum CRP or ESR)
	7	Activity of daily living at home, school, workplace, etc
	8	Functional status (disability), usually assessed by HAQ score
	9	Patient’s preferences for treatment
	10	Information about the effects of the treatment
	11	Information about adverse effects of the treatment
	12	Financial burden of the treatment on the patient

Abbreviations: RA, rheumatoid arthritis; CCP, cyclic citrullinated peptide; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; HAQ, health assessment questionnaire.