Individualized decision aid for diverse women with lupus nephritis

Treatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis. In a United States multicenter, open-label, randomized controlled trial (RCT), adult women with l...

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Bibliographic Details
Published in:PLoS medicine 2019-05, Vol.16 (5)
Main Authors: Singh, Jasvinder A, Fraenkel, Liana, Green, Candace, Alarcón, Graciela S, Barton, Jennifer L, Saag, Kenneth G, Hanrahan, Leslie M, Raymond, Sandra C, Kimberly, Robert P, Leong, Amye L, Reyes, Elyse, Street, Richard L, Suarez-Almazor, Maria E, Eakin, Guy S, Marrow, Laura, Morgan, Charity J, Caro, Brennda, Sloan, Jeffrey A, Jandali, Bochra, Garcia, Salvador R, Grossman, Jennifer, Winthrop, Kevin L, Trupin, Laura, Dall'Era, Maria, Meara, Alexa, Rizvi, Tara, Chatham, W. Winn, Yazdany, Jinoos
Format: Article
Language:English
Subjects:
African Americans
Analysis
Care and treatment
Clinical trials
Decision making
Education
Immunosuppressive agents
Immunotherapy
Kidney diseases
Labels
Lupus
Nephritis
Patient compliance
Secondary education
Social class
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Summary:Treatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis. In a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of
ISSN:1549-1277
1549-1676
DOI:10.1371/journal.pmed.1002800