Reducing Patient Risk Aversion to RA Treatments

Effective Communication Strategies May Hold Key to Improved Patient Outcomes

As a fellow at Boston University in the mid-1990s, Dr. Liana Fraenkel, now a faculty member at the Yale University School of Medicine, took note of the fact that many of the female patients with whom she worked – in particular minority women – were resistant to taking cyclophosphamide or other immunosuppressant drugs to treat their lupus, despite the fact that by not taking the drugs they ran the risk of damage to their kidneys or other organs. Fraenkel consistently found that one of the primary concerns within this group of patients was protecting their fertility. While concern over one’s ability to have children isn’t too unusual, Fraenkel found the higher rate of resistance among particular cultural subgroups of patients notable. This led her to question why people react differently to receiving the same basic information, especially information regarding treatments that could slow progression of their disease or prolong their lives.

This question lies at the heart of Dr. Fraenkel’s research. The recipient of a 2012 Arthritis Foundation Innovative Research Grant,she has designed a unique study to examine patient reactions to different ways of explaining the risks and benefits of arthritis treatments. She hopes the study will help identify effective and practical communication strategies that can be employed in doctors’ offices to increase patient acceptance of treatment and improve outcomes.

Fraenkel began with information from other studies indicating that feelings weigh heavily on a person’s judgment. In other words, positive feelings tend to decrease concern over risks whereas negative feelings increase concerns related to risk. Studies have shown that many patients do not receive sufficient information about the risks of their medications, but studies also show that when given too much information about complex choices, patients become overwhelmed and opt-out or defer treatment. The real question then becomes how to help patients weigh real fears against the best, most accurate information about how they will benefit from treatment.

One of the challenges Fraenkel faced in designing her study was how to accurately evaluate a patient’s true reaction to any particular communication strategy. “People forget how they feel in the moment of hearing specific details,” she says. “We could use a survey or questionnaire after having a patient watch a video, but I really want to be able to understand their reactions to specific information and how it’s delivered in real time to gain a better understanding of patient assessment of risk.”

She gained inspiration while watching the 2008 vice presidential debate on CNN. “During the debate, CNN had an audience panel using a type of joystick to record their reactions to what the candidates were saying. This allowed audience members to react instantly to the ideas being expressed as well as to how they were being expressed. My study utilizes this same technology. In Fraenkel’s study, patients watch three videos, each using a different strategy for conveying the risks of treatment. While watching each video, patients use the joystick to record how they’re feeling at a specific moment while hearing certain information.

“Physicians look at a patient’s illness through the lens of disease activity measurements like pain, swelling, blood tests, or other indicators,” she explains, “but patients experience their illness in other ways. Their decisions to change care may be based on a host of other factors. We need to understand why our guidelines for treatment might not be implemented,” she says.

By including women and minority subjects in her study, Fraenkel hopes her research will provide a fuller understanding of those reasons as well as an effective evaluation of how race, gender, culture, and socioeconomic factors influence risk perception. Once this initial process is complete, she will begin sorting through the data. In the end, she hopes to identify strategies and create best practices that allow doctors to convey the most accurate information about both risks and benefits so that future patient decisions about treatment can be made based on real information and not fear alone.









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