Examining the Level of Shared Decision-Making in RA Clinical Care

An elderly man talking to his doctor about some recent test results.
Improvement is needed in shared decision-making in the treatment of RA, according to researchers in The Netherlands.

Using an observer-based perspective, the level of shared decision-making in rheumatoid arthritis (RA) clinical care was found to be low to moderate, according to study results published in the Annals of the Rheumatic Diseases.

The researchers evaluated the level of shared decision-making in patients treated at 2 rheumatology treatment centers in The Netherlands by analyzing audio recordings of 168 unique patient-provider interactions. In each case, the level of shared decision-making was graded using the observer patient involvement (OPTION) scale, and the relationship between consultation, patient, and clinician characteristics with levels of shared decision-making were examined. Due to the hierarchical nature of the data, multilevel modeling was used in the analysis.

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After analysis, the investigators found that the level of shared decision-making was low to moderate (mean OPTION score, 28.3; standard deviation, 15.1), with a total range of 0 to 75 (max score 100).

In the multilevel analysis, 4 parameters were significantly associated with the level of shared decision-making: decision to administer single dose glucocorticoids (unstandardized coefficient, 15.03; 95% CI, 9.12-20.93), stopping and/or starting medication (unstandardized coefficient, 14.30; 95% CI, 5.62-22.98), adjusting medication doses (unstandardized coefficient, 8.36; 95% CI, 3.92-12.81), and consultation duration (unstandardized coefficient, 0.63; 95% CI, 0.16-1.11).

The researchers acknowledged a key study limitation was its cross-sectional design.

“Overall, the level of [shared decision-making] in RA treatment leaves room for improvement,” they reported.

“Targeted strategies to support the application of [shared decision-making] are warranted in this era of patient-centered care,” they concluded.


Mathijssen EGE, Vriezekolk JE, Popa CD, van den Bemt BJF. Shared decision-making in routine clinical care of patients with rheumatoid arthritis: an assessment of audio-recorded consultations [published online October 29, 2019]. Ann Rheum Dis. doi:10.1136/annrheumdis-2019-216137