Although patient education is essential in rheumatic disease management, it is often deficient in practice. Physicians are often unaware of how much information patients seek and the degree to which they wish to participate in decision making. Development of a generic decision aid could greatly enhance patient education and the inclusion of patient preferences into the practice of medicine and surgery. The effectiveness of such educational tools in enhancing shared decision making regarding major therapeutic options in chronic conditions such as rheumatoid arthritis has not been rigorously evaluated. We will develop and evaluate, in a randomized, controlled trial, an intervention to improve the process by which doctors and patients discuss and decide on major medical and surgical treatment. Four hundred RA patients will be studied. At baseline, patients and physicians will be followed to establish usual practices. In phase 2, physicians will be trained to elicit patients' preferences and expectations and to include them in the medical decision making; patients will be randomly assigned to receive information on benefits and drawbacks of all treatment options being considered, or to receive information plus a questionnaire designed to elicit their expectations for each treatment option and preferences among outcomes, which they will share with the physician. Outcomes include improved communication between doctor and patient, more shared decision making, fewer post-decisional regrets for the patient, and improved sense of control, compliance, and health status for the patient.
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