Shared Decision Making in Rheumatology, the Perspective from Mexican Patients and Physicians: Partnership and Affirmed Dignity.

BACKGROUND

Shared decision-making (SDM) impacts medical and patient-reported outcomes.

OBJECTIVE

The study compared perceptions of SDM between Mexican patients with rheumatic diseases (RMDs) and their attending rheumatologists, identified some factors associated with adequate SDM, and examined the relationship between patient perceptions of SDM and dignity.

PATIENTS AND

METHODS

This cross-sectional study was performed between September 2024 and April 2025. Consecutive patients with RMDs completed validated Spanish versions of SDM (SDM-9-Q) and perceived dignity (PDI-Mx). SDM was assessed in the attending rheumatologists with the SDM-Doc-Q. Adequate SDM was defined as a score of ≥72.6 on the SDM-Q-9. Multivariate regression analysis was used.

RESULTS

Data from 170 patient-physician encounters were analyzed. Scores of the SDM-9-Q and SDM-Q-Doc showed no differences. However, patients scored higher on items pertaining to the need to decide about the treatment, available treatment options, and related information than doctors did. There were 113 patients (66.5%) with adequate SDM. The duration of underlying RMD [Exp (B): 1.046; 95% CI: 1.008-1.085, p = 0.017] and treatment modifications during encounters [Exp (B): 2.099; 95% CI: 1.073-4.105, p = 0.030] were associated with this outcome. Spearman rho between SDM-9-Q score, SDM-9-Q individual items scores, and the PDI-Mx score was inverse and not significant, but for item 2, related to autonomy principle: rho = -0.160, p = 0.037.

CONCLUSIONS

Overall perception of SDM was similar between patients with RMDs and their rheumatologists. RMD-related characteristics were associated with patient' perceptions of adequate SDM, observed in two-thirds of the participants. A weak correlation was observed between patient's autonomy ideal-related to the SDM process and their perceived dignity.