The design of a low literacy decision aid about rheumatoid arthritis medications developed in three languages for use during the clinical encounter

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• 作者：Jennifer L Barton (1) (2)
  Christopher J Koenig (1)
  Gina Evans-Young (1) (3)
  Laura Trupin (1) (3)
  Jennie Anderson (4)
  Dana Ragouzeos (4)
  Maggie Breslin (5)
  Timothy Morse (4)
  Dean Schillinger (1)
  Victor M Montori (6)
  Edward H Yelin (1) (3)
  
  1. Department of Medicine ; University of California ; San Francisco ; CA ; USA
  2. Division of Hospital & Specialty Medicine ; Portland Veterans Affairs Medical Center ; 3710 SW US Veterans Hospital Road ; Portland ; OR ; 97239 ; USA
  3. Phillip R. Lee Institute for Health Policy Studies ; San Francisco ; CA ; USA
  4. San Francisco ; CA ; USA
  5. Brooklyn ; NY ; USA
  6. Knowledge and Evaluation Research Unit ; Mayo Clinic ; Rochester ; MN ; 55905 ; USA
  
• 关键词：Decision aid ; Rheumatoid arthritis ; Health literacy
• 刊名：BMC Medical Informatics and Decision Making
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：1,833 KB
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• 刊物主题：Health Informatics; Information Systems and Communication Service; Management of Computing and Information Systems;
• 出版者：BioMed Central
• ISSN：1472-6947

文摘

Background Shared decision-making in rheumatoid arthritis (RA) care is a priority among policy makers, clinicians and patients both nationally and internationally. Demands on patients to have basic knowledge of RA, treatment options, and details of risk and benefit when making medication decisions with clinicians can be overwhelming, especially for those with limited literacy or limited English language proficiency. The objective of this study is to describe the development of a medication choice decision aid for patients with rheumatoid arthritis (RA) in three languages using low literacy principles. Methods Based on the development of a diabetes decision aid, the RA decision aid (RA Choice) was developed through a collaborative process involving patients, clinicians, designers, decision-aid and health literacy experts. A combination of evidence synthesis and direct observation of clinician-patient interactions generated content and guided an iterative process of prototype development. Results Three iterations of RA Choice were developed and field-tested before completion. The final tool organized data using icons and plain language for 12 RA medications across 5 issues: frequency of administration, time to onset, cost, side effects, and special considerations. The tool successfully created a conversation between clinician and patient, and garnered high acceptability from clinicians. Conclusions The process of collaboratively developing an RA decision aid designed to promote shared decision making resulted in a graphically-enhanced, low literacy tool. The use of RA Choice in the clinical encounter has the potential to enhance communication for RA patients, including those with limited health literacy and limited English language proficiency.